Provider Demographics
NPI:1861573438
Name:HOMEDALE RURAL FIRE PROTECTION DISTRICT
Entity type:Organization
Organization Name:HOMEDALE RURAL FIRE PROTECTION DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:URANGA RYSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-337-3546
Mailing Address - Street 1:6116 GRAYE LN
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-8072
Mailing Address - Country:US
Mailing Address - Phone:208-795-6930
Mailing Address - Fax:208-795-6931
Practice Address - Street 1:9 WEST COLORADO AVE
Practice Address - Street 2:
Practice Address - City:HOMEDALE
Practice Address - State:ID
Practice Address - Zip Code:83628
Practice Address - Country:US
Practice Address - Phone:208-482-4662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID53023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDE0211OtherBLUE CROSS
ID000010014554OtherBLUE SHIELD
ID002874400Medicaid