Organization
TOWN OF HEBRON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY T GENTILE (AUTHORIZED AGENT)
(860) 257-9201
Entity
Organization
Contact information
Practice address
44 MAIN ST, HEBRON, CT 06248-1515
(860) 228-3022
(860) 228-0711
Mailing address
PO BOX 290184, WETHERSFIELD, CT 06129-0184
(860) 257-9201
(860) 721-6362
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
C067B1
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004119865
—
CT
01
—
590007146
MEDICARE RAILROAD
CT
Enumeration date
10/26/2005
Last updated
06/18/2008
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