Healthcare Provider Details

I. General information

NPI: 1720070915
Provider Name (Legal Business Name): EAST GRANBY AMBULANCE ASSN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MEMORIAL DR
EAST GRANBY CT
06026-9632
US

IV. Provider business mailing address

PO BOX 282
EAST GRANBY CT
06026-0282
US

V. Phone/Fax

Practice location:
  • Phone: 860-653-4165
  • Fax:
Mailing address:
  • Phone: 860-668-3885
  • Fax: 860-668-3885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberC040B1
License Number StateCT

VIII. Authorized Official

Name: MS. DELORES LINDQUIST
Title or Position: PRESIDENT
Credential:
Phone: 860-653-4165