Provider Demographics
NPI:1891828554
Name:VILLAGE OF CLOUDCROFT
Entity Type:Organization
Organization Name:VILLAGE OF CLOUDCROFT
Other - Org Name:CLOUDCROFT AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRULKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-682-2411
Mailing Address - Street 1:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:CLOUDCROFT
Mailing Address - State:NM
Mailing Address - Zip Code:88317-0317
Mailing Address - Country:US
Mailing Address - Phone:505-682-2411
Mailing Address - Fax:505-682-2042
Practice Address - Street 1:1100 JAMES CANYON HWY
Practice Address - Street 2:
Practice Address - City:CLOUDCROFT
Practice Address - State:NM
Practice Address - Zip Code:88317-0317
Practice Address - Country:US
Practice Address - Phone:505-682-3409
Practice Address - Fax:505-682-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA2667Medicaid