Provider Demographics
NPI:1174892210
Name:CENTRAL CASCADES FIRE & EMS
Entity type:Organization
Organization Name:CENTRAL CASCADES FIRE & EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:EMT- BASIC
Authorized Official - Phone:541-433-2800
Mailing Address - Street 1:PO BOX 1065
Mailing Address - Street 2:
Mailing Address - City:CRESCENT LAKE
Mailing Address - State:OR
Mailing Address - Zip Code:97733-1065
Mailing Address - Country:US
Mailing Address - Phone:541-433-2800
Mailing Address - Fax:
Practice Address - Street 1:20400 CRESCENT LAKE HWY
Practice Address - Street 2:
Practice Address - City:CRESCENT LAKE
Practice Address - State:OR
Practice Address - Zip Code:97733-7044
Practice Address - Country:US
Practice Address - Phone:541-433-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR134610146N00000X
OR133419146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty