Healthcare Provider Details

I. General information

NPI: 1265434690
Provider Name (Legal Business Name): GRANBY AMBULANCE ASSOCIATION, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PEGVILLE ROAD
GRANBY CT
06035-1615
US

IV. Provider business mailing address

1 PEGVILLE ROAD
GRANBY CT
06035-1615
US

V. Phone/Fax

Practice location:
  • Phone: 860-653-6535
  • Fax: 888-965-4620
Mailing address:
  • Phone: 860-653-6535
  • Fax: 888-965-4620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberC056B1
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: LORI DIBATTISTO
Title or Position: PRESTIDENT
Credential:
Phone: 860-653-6535