Provider Demographics
NPI:1679678007
Name:TOWN OF GUILFORD
Entity Type:Organization
Organization Name:TOWN OF GUILFORD
Other - Org Name:TOWN OF GUILFORD FD AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF DEPARTMENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRSCAHFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-453-8056
Mailing Address - Street 1:390 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2004
Mailing Address - Country:US
Mailing Address - Phone:203-453-8045
Mailing Address - Fax:203-453-8005
Practice Address - Street 1:390 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2004
Practice Address - Country:US
Practice Address - Phone:203-453-8045
Practice Address - Fax:203-453-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC060P1341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT710C060I1CT01OtherANTHEM BLUE CROSS
CT004010500Medicaid
CT710C060I1CT01OtherANTHEM BLUE CROSS