Provider Demographics
NPI:1679665970
Name:WESTSIDE COMMUNITY HEALTHCARE DISTRICT
Entity Type:Organization
Organization Name:WESTSIDE COMMUNITY HEALTHCARE DISTRICT
Other - Org Name:WESTSIDE COMMUNITY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/BOARD CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BRAZIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-862-2951
Mailing Address - Street 1:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:NEWMAN
Mailing Address - State:CA
Mailing Address - Zip Code:95360-0746
Mailing Address - Country:US
Mailing Address - Phone:209-862-2951
Mailing Address - Fax:786-725-3470
Practice Address - Street 1:151 SOUTH HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:NEWMAN
Practice Address - State:CA
Practice Address - Zip Code:95360
Practice Address - Country:US
Practice Address - Phone:209-862-2951
Practice Address - Fax:209-854-2174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00175FMedicaid
CAZZZ97541ZOtherMEDICARE PTAN