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Organization
ELLINGTON VOLUNTEER AMB
Active
Organization
ELLINGTON VOLUNTEER AMB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. HEATHER M LIZOTTE (AUTHORIZED AGENT)
(800) 452-8191
Entity
Organization
Contact information
Practice address
41 MAPLE ST, ELLINGTON, CT 06029-3333
(860) 870-3170
(860) 870-3173
Mailing address
PO BOX 290184, WETHERSFIELD, CT 06129-0184
(800) 452-8191
(860) 721-6362
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
C048B1
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004180428
—
CT
01
—
590011751
RAILROAD MEDICARE
—
Enumeration date
10/11/2005
Last updated
06/13/2008
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