Provider Demographics
NPI:1972073963
Name:RIVERSIDE FIRE AUTHORITY
Entity type:Organization
Organization Name:RIVERSIDE FIRE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:KYTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-736-3975
Mailing Address - Street 1:1818 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-1905
Mailing Address - Country:US
Mailing Address - Phone:360-736-3975
Mailing Address - Fax:360-330-5573
Practice Address - Street 1:1818 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-1905
Practice Address - Country:US
Practice Address - Phone:360-736-3975
Practice Address - Fax:360-330-5573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601138655OtherBUSINESS LICENSE