Provider Demographics
NPI:1295886786
Name:CLOVERDALE HOSPITAL DISTRICT AMBULANCE
Entity type:Organization
Organization Name:CLOVERDALE HOSPITAL DISTRICT AMBULANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:HINRICHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-894-5862
Mailing Address - Street 1:209 N MAIN ST
Mailing Address - Street 2:P.O. BOX 33
Mailing Address - City:CLOVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95425-3333
Mailing Address - Country:US
Mailing Address - Phone:707-894-5862
Mailing Address - Fax:707-894-9532
Practice Address - Street 1:209 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:CA
Practice Address - Zip Code:95425-3333
Practice Address - Country:US
Practice Address - Phone:707-894-5862
Practice Address - Fax:707-894-9532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ82638ZMedicaid
CAZZZ82638ZMedicare PIN