Provider Demographics
NPI:1760843114
Name:YUCCA FIRE DEPARTMENT
Entity Type:Organization
Organization Name:YUCCA FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:928-766-2300
Mailing Address - Street 1:12349 S FRONTAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:YUCCA
Mailing Address - State:AZ
Mailing Address - Zip Code:86438
Mailing Address - Country:US
Mailing Address - Phone:928-766-2300
Mailing Address - Fax:928-766-2363
Practice Address - Street 1:12349 S FRONTAGE ROAD
Practice Address - Street 2:
Practice Address - City:YUCCA
Practice Address - State:AZ
Practice Address - Zip Code:86438
Practice Address - Country:US
Practice Address - Phone:928-766-2300
Practice Address - Fax:928-766-2363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1317341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance