1487642849 NPI number — CHESTER HOSE COMPANY INCORPORATED

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487642849 NPI number — CHESTER HOSE COMPANY INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESTER HOSE COMPANY INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487642849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
195 ROUTE 80
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILLINGWORTH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06419-1400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-663-3634
Provider Business Mailing Address Fax Number:
860-663-3795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06412-1117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-526-0019
Provider Business Practice Location Address Fax Number:
860-526-6450
Provider Enumeration Date:
10/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CASTIEVETRO
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING AGENT
Authorized Official Telephone Number:
860-663-3634

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  C026B2 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00174598 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004216546 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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