Provider Demographics
NPI:1851828156
Name:ELEPHANT HEAD VOLUNTEER FIRE DEPARTMENT, INC.
Entity type:Organization
Organization Name:ELEPHANT HEAD VOLUNTEER FIRE DEPARTMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:DOV
Authorized Official - Middle Name:
Authorized Official - Last Name:INZLICHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-599-4732
Mailing Address - Street 1:PO BOX 6385
Mailing Address - Street 2:
Mailing Address - City:AMADO
Mailing Address - State:AZ
Mailing Address - Zip Code:85645-6385
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28770 S OLD NOGALES HWY
Practice Address - Street 2:
Practice Address - City:AMADO
Practice Address - State:AZ
Practice Address - Zip Code:85645
Practice Address - Country:US
Practice Address - Phone:520-505-5717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance