Provider Demographics
NPI:1386731271
Name:WESTBROOK AMBULANCE ASSOCIATION, INC
Entity type:Organization
Organization Name:WESTBROOK AMBULANCE ASSOCIATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTLEVETRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-663-3634
Mailing Address - Street 1:PO BOX 682
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06498-0682
Mailing Address - Country:US
Mailing Address - Phone:860-663-3634
Mailing Address - Fax:860-663-3795
Practice Address - Street 1:1316 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-1972
Practice Address - Country:US
Practice Address - Phone:860-663-3634
Practice Address - Fax:860-663-3795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE45153416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT732661OtherCONNECTICARE
CTCT7461OtherHEALTHNET
CT=========OtherTRICARE