Provider Demographics
NPI:1801515614
Name:CITY OF CASA GRANDE
Entity type:Organization
Organization Name:CITY OF CASA GRANDE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-421-8777
Mailing Address - Street 1:377 E VAL VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-6900
Mailing Address - Country:US
Mailing Address - Phone:520-421-8777
Mailing Address - Fax:520-836-1129
Practice Address - Street 1:377 E VAL VISTA BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-6900
Practice Address - Country:US
Practice Address - Phone:520-421-8777
Practice Address - Fax:520-836-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance