Basic Information
| Provider Information | |||||||||
| NPI: | 1104913086 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEEP RIVER AMBULANCE ASSOCIATION, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 274 | ||||||||
| Address2: | |||||||||
| City: | DEEP RIVER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064170274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606633634 | ||||||||
| FaxNumber: | 8606633795 | ||||||||
| Practice Location | |||||||||
| Address1: | 284 W ELM ST | ||||||||
| Address2: | |||||||||
| City: | DEEP RIVER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064171617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606633634 | ||||||||
| FaxNumber: | 8606633795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CASTLEVETRO | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8606633634 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | E3581 | CT | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | N291876 | 01 | CT | OXFORD | OTHER | 495263 | 01 | CT | CONNECTICARE | OTHER | CT8252 | 01 | CT | HEALTHNET | OTHER |