Provider Demographics
NPI:1548252737
Name:WINDSOR LOCKS LIONS CHARITIES INC.
Entity type:Organization
Organization Name:WINDSOR LOCKS LIONS CHARITIES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:GERES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-627-1411
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:WINDSOR LOCKS
Mailing Address - State:CT
Mailing Address - Zip Code:06096-0105
Mailing Address - Country:US
Mailing Address - Phone:860-668-3885
Mailing Address - Fax:860-668-3885
Practice Address - Street 1:401 SPRING ST
Practice Address - Street 2:
Practice Address - City:WINDSOR LOCKS
Practice Address - State:CT
Practice Address - Zip Code:06096-1744
Practice Address - Country:US
Practice Address - Phone:860-627-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC165B1341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
590008996OtherRAILROAD MEDICARE
CT710C165B1CT01OtherANTHEM BCBS
CT004137619Medicaid
613128OtherCONNECTICARE
104753000OtherDEPT OF LABOR
=========OtherTRICARE
CT004137619Medicaid