Provider Demographics
NPI:1487642849
Name:CHESTER HOSE COMPANY INCORPORATED
Entity Type:Organization
Organization Name:CHESTER HOSE COMPANY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTIEVETRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-663-3634
Mailing Address - Street 1:195 ROUTE 80
Mailing Address - Street 2:
Mailing Address - City:KILLINGWORTH
Mailing Address - State:CT
Mailing Address - Zip Code:06419-1400
Mailing Address - Country:US
Mailing Address - Phone:860-663-3634
Mailing Address - Fax:860-663-3795
Practice Address - Street 1:6 HIGH ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:CT
Practice Address - Zip Code:06412-1117
Practice Address - Country:US
Practice Address - Phone:860-526-0019
Practice Address - Fax:860-526-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC026B2341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00174598OtherRAILROAD MEDICARE
CT004216546Medicaid
CT590000209Medicare PIN