Organization
OLD LYME SOUTH END VOLUNTEER AMBULANCE
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
22 CROSS LN, OLD LYME, CT 06371-2115
(860) 434-0089
(860) 434-8052
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
C105B1
CT
Other
Enumeration date
10/26/2005
Last updated
03/13/2008
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