Provider Demographics
NPI:1962476317
Name:CITY OF LYNDEN
Entity Type:Organization
Organization Name:CITY OF LYNDEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ALESSANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-354-4400
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-0671
Mailing Address - Country:US
Mailing Address - Phone:360-654-4400
Mailing Address - Fax:360-354-1452
Practice Address - Street 1:215 4TH ST
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1903
Practice Address - Country:US
Practice Address - Phone:360-354-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA37M073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1257CIOtherREGENCE
WA0176046OtherL&I AND CRIME VICTIMS
WA9138702Medicaid
WAP00124652Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WAG001400041Medicare PIN