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General NPI Number Information
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NPI Number | 1265434690
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Entity Type | Organization
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Legal Business Name | GRANBY AMBULANCE ASSOCIATION, INCORPORATED
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 1 PEGVILLE ROAD
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City | GRANBY
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State | CT
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Zip | 06035-1615
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Country | US
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Telephone | 860-653-6535
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Fax | 888-965-4620
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Provider Business Mailing Address
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Address Line | 1 PEGVILLE ROAD
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City | GRANBY
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State | CT
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Zip | 06035-1615
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Country | US
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Telephone | 860-653-6535
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Fax | 888-965-4620
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Authorized Official
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Title or Position | PRESTIDENT
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Name | LORI DIBATTISTO
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Credential |
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Telephone | 860-653-6535
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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 |
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License Number State |
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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 | C056B1
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License Number State | CT
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