Provider Demographics
NPI:1063662658
Name:TOWN OF GRAFTON
Entity Type:Organization
Organization Name:TOWN OF GRAFTON
Other - Org Name:GRAFTON VOLUNTEER AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MS
Authorized Official - First Name:DOTTI
Authorized Official - Middle Name:
Authorized Official - Last Name:ERNST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-523-7500
Mailing Address - Street 1:PO BOX 290184
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06129-0184
Mailing Address - Country:US
Mailing Address - Phone:860-257-7080
Mailing Address - Fax:860-563-3403
Practice Address - Street 1:5 LIBRARY RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:NH
Practice Address - Zip Code:03240
Practice Address - Country:US
Practice Address - Phone:603-523-7500
Practice Address - Fax:603-523-4026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0043341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3078834Medicaid
NH0008414Medicare PIN