Organization
GARDNER LAKE VOLUNTEER FIRE COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY GENTILE (AUTHORIZED AGENT)
(800) 452-8191
Entity
Organization
Contact information
Practice address
429 OLD COLCHESTER RD, SALEM, CT 06420-3748
(860) 859-1743
(860) 892-5392
Mailing address
PO BOX 290184, WETHERSFIELD, CT 06129-0184
(800) 452-8191
(860) 563-3403
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
C121B1
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004211158
—
CT
01
—
P00606334
RAILROAD
CT
Enumeration date
10/10/2005
Last updated
09/23/2008
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