Provider Demographics
NPI:1639356298
Name:CONNECTICUT HANDIVAN, INC.
Entity Type:Organization
Organization Name:CONNECTICUT HANDIVAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANICO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:203-562-1760
Mailing Address - Street 1:208 QUINNIPIAC AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3626
Mailing Address - Country:US
Mailing Address - Phone:203-562-1760
Mailing Address - Fax:
Practice Address - Street 1:208 QUINNIPIAC AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3626
Practice Address - Country:US
Practice Address - Phone:203-562-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2601343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)