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General NPI Number Information
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NPI Number | 1720070915
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Entity Type | Organization
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Legal Business Name | EAST GRANBY AMBULANCE ASSN
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 6 MEMORIAL DR
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City | EAST GRANBY
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State | CT
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Zip | 06026-9632
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Country | US
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Telephone | 860-653-4165
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 282
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City | EAST GRANBY
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State | CT
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Zip | 06026-0282
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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 | PRESIDENT
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Name | MS. DELORES LINDQUIST
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Credential |
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Telephone | 860-653-4165
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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 | C040B1
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License Number State | CT
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