Healthcare Provider Details

I. General information

NPI: 1871581264
Provider Name (Legal Business Name): TOWN OF TOLLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 TOLLAND GRN
TOLLAND CT
06084-3028
US

IV. Provider business mailing address

PO BOX 290184
WETHERSFIELD CT
06129-0184
US

V. Phone/Fax

Practice location:
  • Phone: 860-871-3677
  • Fax: 860-871-3687
Mailing address:
  • Phone: 800-452-8191
  • Fax: 860-563-3403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberC142B1
License Number StateCT

VIII. Authorized Official

Name: MRS. MARY T GENTILE
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 800-452-8191