Provider Demographics
NPI:1841290665
Name:THE COMMUNITY FIRE COMPANY OF NORTH GROSVENORDALE CT INC.
Entity type:Organization
Organization Name:THE COMMUNITY FIRE COMPANY OF NORTH GROSVENORDALE CT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MERRILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-923-9444
Mailing Address - Street 1:269 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2302
Mailing Address - Country:US
Mailing Address - Phone:860-638-1800
Mailing Address - Fax:860-638-1802
Practice Address - Street 1:862 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH GROSVENORDALE
Practice Address - State:CT
Practice Address - Zip Code:06255-1729
Practice Address - Country:US
Practice Address - Phone:860-923-9444
Practice Address - Fax:860-923-9720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004173895Medicaid
710C141A2CT01OtherBLUE CROSS/BLUE SHIELD
=========00OtherBLUE CARE FAMILY PLAN
=========00OtherBLUE CARE FAMILY PLAN