Provider Demographics
NPI:1770819781
Name:VIEJAS BAND OF KUMEYAAY INDIANS
Entity Type:Organization
Organization Name:VIEJAS BAND OF KUMEYAAY INDIANS
Other - Org Name:VIEJAS FIRE DEPARTMENT/VIEJAS AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:BUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-659-2374
Mailing Address - Street 1:PO BOX 269110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-9110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 VIEJAS GRADE RD
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-1605
Practice Address - Country:US
Practice Address - Phone:619-659-2374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770819781Medicaid
CA1770819781Medicaid