Healthcare Provider Details

I. General information

NPI: 1689265258
Provider Name (Legal Business Name): PULASKI COUNTY BOARD OF SUPERVISORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CLEBURNE BLVD
DUBLIN VA
24084-9998
US

IV. Provider business mailing address

PO BOX 290184
WETHERSFIELD CT
06129-0184
US

V. Phone/Fax

Practice location:
  • Phone: 540-633-6738
  • Fax: 540-633-6745
Mailing address:
  • Phone: 860-257-7080
  • Fax: 860-563-3403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: MARY T GENTILE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 860-257-7080