Organization
HERITAGE VILLAGE AMBULANCE ASSOCIATION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN PELLETIER (PRESIDENT)
(203) 264-9543
Entity
Organization
Contact information
Practice address
588 EAST HILL ROAD, SOUTHBURY, CT 06488-1389
(203) 264-9543
Mailing address
269 MAIN ST, CROMWELL, CT 06416-2302
(860) 638-1800
(860) 638-1802
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004239027
—
CT
01
—
710C130C2CT01
BLUE CROSS/BLUE SHIELD
—
01
—
CV2214
HEALTHNET
—
Enumeration date
08/04/2005
Last updated
08/13/2012
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