Provider Demographics
NPI:1770817553
Name:NASELLE VOLUNTEER FIRE DEPARTMENT, INC.
Entity Type:Organization
Organization Name:NASELLE VOLUNTEER FIRE DEPARTMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:HAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:1ST RESPONDER
Authorized Official - Phone:360-484-7187
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:NASELLE
Mailing Address - State:WA
Mailing Address - Zip Code:98638-0054
Mailing Address - Country:US
Mailing Address - Phone:360-484-7187
Mailing Address - Fax:360-484-7187
Practice Address - Street 1:5 COUNTY SHED ROAD
Practice Address - Street 2:
Practice Address - City:NASELLE
Practice Address - State:WA
Practice Address - Zip Code:98638-0054
Practice Address - Country:US
Practice Address - Phone:360-484-7187
Practice Address - Fax:360-484-7187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAW23058Medicare UPIN
WA000800104Medicare PIN