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General NPI Number Information
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NPI Number | 1164410601
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Entity Type | Organization
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Legal Business Name | GARDNER LAKE VOLUNTEER FIRE COMPANY
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 429 OLD COLCHESTER RD
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City | SALEM
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State | CT
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Zip | 06420-3748
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Country | US
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Telephone | 860-859-1743
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Fax | 860-892-5392
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Provider Business Mailing Address
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Address Line | PO BOX 290184
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City | WETHERSFIELD
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State | CT
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Zip | 06129-0184
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Country | US
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Telephone | 800-452-8191
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Fax | 860-563-3403
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Authorized Official
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Title or Position | AUTHORIZED AGENT
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Name | MARY GENTILE
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Credential |
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Telephone | 800-452-8191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | C121B1
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License Number State | CT
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