Organization
POLASKI COUNTY BOARD OF SUPERVISORS
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
6580 VALLEY CENTER DR, STE 118, FAIRLAWN, VA 24141-5669
(540) 633-6743
(540) 633-6745
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
856
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009011293
—
VA
01
—
590009886
RAILROAD MEDICARE
—
Enumeration date
10/26/2005
Last updated
01/13/2020
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