# SOUTH LAKE TAHOE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659438505
- **Authorized official:** SALLIE ROSS (ADMINISTRATIVE ASSISTANT)
- **Authorized official phone:** (530) 542-6152

## Contact information

- **Practice address:** 2101 LAKE TAHOE BLVD, SOUTH LAKE TAHOE, CA 96150-6424
- **Practice address phone:** (530) 542-6164
- **Mailing address:** PO BOX 510, ALAMEDA, CA 94501-9610

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | — | — | Yes |

## Other

- **Enumeration date:** 01/02/2007
- **Last updated:** 06/30/2008