MEDICARE: WINDSOR LOCKS LIONS CHARITIES INC.

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	C165B1	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590008996	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	710C165B1CT01	OTHER	CT	ANTHEM BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	613128	OTHER		CONNECTICARE
5	104753000	OTHER		DEPT OF LABOR

General Provider Information

NPI Number	:	1548252737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINDSOR LOCKS LIONS CHARITIES INC.

Provider Business Mailing Address
First Line	:	PO BOX 105
Second Line	:
City	:	WINDSOR LOCKS
State	:	CT
Zip	:	06096-0105
Country	:	US
Telephone Number	:	860-668-3885
Fax Number	:	860-668-3885

Provider Business Practice Location Address
First Line	:	401 SPRING ST
Second Line	:
City	:	WINDSOR LOCKS
State	:	CT
Zip	:	06096-1744
Country	:	US
Telephone Number	:	860-627-1411
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR COORDINATOR
Name	:	MR. STUART GERES
Credential	:
Telephone Number	:	860-627-1411

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	11/29/2017

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