Provider Demographics
NPI:1912911868
Name:IDANHA DETROIT RURAL FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:IDANHA DETROIT RURAL FIRE PROTECTION DISTRICT
Other - Org Name:IDANHA-DETROIT RFPD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALBRAITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-854-3494
Mailing Address - Street 1:PO BOX 3510
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3510
Mailing Address - Country:US
Mailing Address - Phone:360-394-7020
Mailing Address - Fax:360-394-7099
Practice Address - Street 1:160 DETROIT AVE N
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:OR
Practice Address - Zip Code:97342
Practice Address - Country:US
Practice Address - Phone:503-854-3494
Practice Address - Fax:503-854-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR093187Medicaid
OR0000 RGBKTMedicare PIN
OR0000 RGBKTMedicare UPIN
OR093187Medicaid
0000RGBKTMedicare PIN