Healthcare Provider Details

I. General information

NPI: 1063400414
Provider Name (Legal Business Name): WILLINGTON FIRE DEPT #1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 RIVER RD
WILLINGTON CT
06279-1310
US

IV. Provider business mailing address

PO BOX 204
W SUFFIELD CT
06093
US

V. Phone/Fax

Practice location:
  • Phone: 860-429-0288
  • Fax: 860-487-4545
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 NumberC160B1
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberC160B1
License Number StateCT

VIII. Authorized Official

Name: MR. RONALD GANTICK
Title or Position: AMBULANCE CHIEF
Credential:
Phone: 860-429-0288