Healthcare Provider Details

I. General information

NPI: 1194731661
Provider Name (Legal Business Name): TOWN OF WRENTHAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 SOUTH ST
WRENTHAM MA
02093-1526
US

IV. Provider business mailing address

99 SOUTH ST P.O. BOX 614
WRENTHAM MA
02093-1526
US

V. Phone/Fax

Practice location:
  • Phone: 508-384-3131
  • Fax: 508-384-7468
Mailing address:
  • Phone: 508-384-3131
  • Fax: 508-384-7468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number3423
License Number StateMA

VIII. Authorized Official

Name: MARK S. PARE
Title or Position: FIRE CHIEF
Credential:
Phone: 508-384-3131