Organization
TOWN OF TOLLAND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY T GENTILE (AUTHORIZED AGENT)
(800) 452-8191
Entity
Organization
Contact information
Practice address
21 TOLLAND GRN, TOLLAND, CT 06084-3028
(860) 871-3677
(860) 871-3687
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
C142B1
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004091493
—
CT
01
—
590014253
RAILROAD MEDICARE
—
Enumeration date
10/10/2005
Last updated
04/02/2009
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