Provider Demographics
NPI:1790788305
Name:BASALT & RURAL FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:BASALT & RURAL FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-704-0675
Mailing Address - Street 1:1089 JW DRIVE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-9587
Mailing Address - Country:US
Mailing Address - Phone:970-704-0675
Mailing Address - Fax:970-704-0625
Practice Address - Street 1:1089 JW DRIVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-9587
Practice Address - Country:US
Practice Address - Phone:970-704-0675
Practice Address - Fax:970-704-0625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3416L0300X
CO007-2011,008-2011,003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06604433Medicaid
COC60443Medicare PIN