Healthcare Provider Details

I. General information

NPI: 1295720043
Provider Name (Legal Business Name): LEBANON VOLUNTEER FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 GOSHEN HILL RD
LEBANON CT
06249-1710
US

IV. Provider business mailing address

269 MAIN ST
CROMWELL CT
06416-2302
US

V. Phone/Fax

Practice location:
  • Phone: 860-642-7546
  • Fax:
Mailing address:
  • Phone: 860-638-1800
  • Fax: 860-638-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BETSY PETRIE
Title or Position: CAPTAIN
Credential:
Phone: 860-642-7546