Healthcare Provider Details

I. General information

NPI: 1801896634
Provider Name (Legal Business Name): EAST HADDAM AMBULANCE ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 TOWN ST.
EAST HADDAM CT
06423
US

IV. Provider business mailing address

195 ROUTE 80
KILLINGWORTH CT
06419-1400
US

V. Phone/Fax

Practice location:
  • Phone: 860-873-2838
  • Fax: 860-446-0130
Mailing address:
  • Phone: 860-873-2838
  • Fax: 860-828-2144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MRS. TIFFANY S QUINN
Title or Position: SERVICE ADMIN.
Credential:
Phone: 860-873-5058