Gardner Lake Volunteer Fire Company

Primary specialty

AmbulanceTaxonomy code 341600000X

License

C121B1 Issued in CT

Legal business name

GARDNER LAKE VOLUNTEER FIRE COMPANY

Practice address

429 Old Colchester Rd
Salem, CT 06420-3748

Phone

(860) 859-1743

Fax

(860) 892-5392

NPI assigned

Oct 10, 2005

Last updated

Sep 23, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary Gentile

Title

Authorized Agent

Phone

(800) 452-8191

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222128000000",
    "number": "1164410601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290184",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061290184",
            "telephone_number": "800-452-8191",
            "fax_number": "860-563-3403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 OLD COLCHESTER RD",
            "city": "SALEM",
            "state": "CT",
            "postal_code": "064203748",
            "telephone_number": "860-859-1743",
            "fax_number": "860-892-5392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDNER LAKE VOLUNTEER FIRE COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-10",
        "last_updated": "2008-09-23",
        "status": "A",
        "authorized_official_last_name": "GENTILE",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "800-452-8191"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "CT",
            "license": "C121B1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00606334",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004211158",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Cappello, DPT
• Lindsay Cochefski
• Shannon Demi, M.ED, BCBA
• Natalie D Edwards, PTA
• Freedom Care One LLC
• Joan Giordano, M.D.
• Alla Gorenbeyn, DMD
• Shannon Woodward D'Aquila Haynes, R.D., CD-N
• Donda Lynn Hilke
• Joan Giordano, MD, LLC

• Ambulance in Salem, CT
• Providers in Salem, CT by specialty
• Ambulance in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.