Provider Demographics
NPI:1861420929
Name:LAKE MOHAVE RANCHOS FIRE DISTRICT
Entity type:Organization
Organization Name:LAKE MOHAVE RANCHOS FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-767-3300
Mailing Address - Street 1:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:DOLAN SPRINGS
Mailing Address - State:AZ
Mailing Address - Zip Code:86441-0611
Mailing Address - Country:US
Mailing Address - Phone:928-767-3300
Mailing Address - Fax:928-767-3301
Practice Address - Street 1:16126 PIERCE FERRY RD.
Practice Address - Street 2:
Practice Address - City:DOLAN SPRINGS
Practice Address - State:AZ
Practice Address - Zip Code:86441-0611
Practice Address - Country:US
Practice Address - Phone:928-767-3300
Practice Address - Fax:928-767-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07447537Z3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ166927OtherAHCCCS PROVIDER NO.
AZ166927OtherAHCCCS PROVIDER NO.
AZ590009558Medicare ID - Type UnspecifiedMEDICARE RR PROVIDER NO.