Provider Demographics
NPI:1184070112
Name:CHILOQUIN - AGENCY LAKE RURAL FIRE PROTECTION DISTRICT
Entity type:Organization
Organization Name:CHILOQUIN - AGENCY LAKE RURAL FIRE PROTECTION DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-783-3860
Mailing Address - Street 1:PO BOX 437
Mailing Address - Street 2:127 S FIRST AVE
Mailing Address - City:CHILOQUIN
Mailing Address - State:OR
Mailing Address - Zip Code:97624-0437
Mailing Address - Country:US
Mailing Address - Phone:541-783-3860
Mailing Address - Fax:541-783-3697
Practice Address - Street 1:127 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:CHILOQUIN
Practice Address - State:OR
Practice Address - Zip Code:97624-9738
Practice Address - Country:US
Practice Address - Phone:541-783-3860
Practice Address - Fax:541-783-3697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport