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General NPI Number Information
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NPI Number | 1063400414
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Entity Type | Organization
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Legal Business Name | WILLINGTON FIRE DEPT #1
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 08/22/2013
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Provider Practice Location Address
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Address Line | 426 RIVER RD
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City | WILLINGTON
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State | CT
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Zip | 06279-1310
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Country | US
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Telephone | 860-429-0288
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Fax | 860-487-4545
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Provider Business Mailing Address
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Address Line | PO BOX 204
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City | W SUFFIELD
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State | CT
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Zip | 06093
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Country | US
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Telephone | 860-668-3885
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Fax | 860-668-3885
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Authorized Official
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Title or Position | AMBULANCE CHIEF
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Name | MR. RONALD GANTICK
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Credential |
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Telephone | 860-429-0288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | C160B1
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | C160B1
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License Number State | CT
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