Provider Demographics
NPI:1750686655
Name:SACRED HEART AMBULANCE CORP
Entity Type:Organization
Organization Name:SACRED HEART AMBULANCE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-780-1061
Mailing Address - Street 1:1305 W ARROW HWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2336
Mailing Address - Country:US
Mailing Address - Phone:626-780-1061
Mailing Address - Fax:
Practice Address - Street 1:1305 W ARROW HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2336
Practice Address - Country:US
Practice Address - Phone:626-780-1061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance