MEDICARE: VILLAGE OF LYONS FALLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508934449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF LYONS FALLS

Provider Business Mailing Address
First Line	:	PO BOX 290184
Second Line	:
City	:	WETHERSFIELD
State	:	CT
Zip	:	06129-0184
Country	:	US
Telephone Number	:	860-257-7080
Fax Number	:	860-563-3403

Provider Business Practice Location Address
First Line	:	3907 HIGH ST
Second Line	:
City	:	LYONS FALLS
State	:	NY
Zip	:	13368
Country	:	US
Telephone Number	:	315-348-5271
Fax Number	:	315-348-5271

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MRS. MARY T GENTILE
Credential	:
Telephone Number	:	860-257-7080

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	10/15/2019

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Directions to “VILLAGE OF LYONS FALLS ” Practice Location

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