1043307432 NPI number — FAMILY SERVICES OF CENTRAL CONNECTICUT, INC.

Table of content: (NPI 1043307432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043307432 NPI number — FAMILY SERVICES OF CENTRAL CONNECTICUT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY SERVICES OF CENTRAL CONNECTICUT, INC.
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:
1043307432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
92 VINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRITAIN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06052-1433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-223-9291
Provider Business Mailing Address Fax Number:
860-223-3111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 COLONY ST
Provider Second Line Business Practice Location Address:
SUITES 301 7 303
Provider Business Practice Location Address City Name:
MERIDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06451-3272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-235-7923
Provider Business Practice Location Address Fax Number:
203-235-0013
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MURADIAN
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
860-826-1358

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  0383 , 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: ANC1482 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CTGA000438 B10006 . This is a "SAGA GRP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 77ABH0021CT01 . This is a "ANTHEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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