# LEBANON VOLUNTEER FIRE DEPARTMENT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295720043
- **Authorized official:** BETSY PETRIE (CAPTAIN)
- **Authorized official phone:** (860) 642-7546

## Contact information

- **Practice address:** 23 GOSHEN HILL RD, LEBANON, CT 06249-1710
- **Practice address phone:** (860) 642-7546
- **Mailing address:** 269 MAIN ST, CROMWELL, CT 06416-2302
- **Mailing address phone:** (860) 638-1800
- **Mailing address fax:** (860) 638-1802

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | — | NULL | Yes |

## Other

- **Enumeration date:** 09/19/2005
- **Last updated:** 09/17/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 004239952 | — | CT |
| 01 | — | 710C071B1CT01 | BLUE CROSS/BLUE SHIELD | — |
| 01 | — | CU6728 | HEALTHNET | — |