Provider Demographics
NPI:1003941675
Name:KWAJALEIN RANGE SERVICES
Entity type:Organization
Organization Name:KWAJALEIN RANGE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR, BUSINESS OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:LINN
Authorized Official - Middle Name:
Authorized Official - Last Name:EZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-355-2220
Mailing Address - Street 1:PO BOX 1321
Mailing Address - Street 2:OCEAN ROAD
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96555
Mailing Address - Country:US
Mailing Address - Phone:805-355-2220
Mailing Address - Fax:805-355-1885
Practice Address - Street 1:OCEAN ROAD
Practice Address - Street 2:BOX 1702
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96555
Practice Address - Country:UM
Practice Address - Phone:805-355-2220
Practice Address - Fax:805-355-1885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE -NOT IN U.S.282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access