Healthcare Provider Details

I. General information

NPI: 1487642849
Provider Name (Legal Business Name): CHESTER HOSE COMPANY INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HIGH ST
CHESTER CT
06412-1117
US

IV. Provider business mailing address

195 ROUTE 80
KILLINGWORTH CT
06419-1400
US

V. Phone/Fax

Practice location:
  • Phone: 860-526-0019
  • Fax: 860-526-6450
Mailing address:
  • Phone: 860-663-3634
  • Fax: 860-663-3795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberC026B2
License Number StateCT

VIII. Authorized Official

Name: SANDRA CASTIEVETRO
Title or Position: BILLING AGENT
Credential:
Phone: 860-663-3634