1164513388 NPI number — TOWN OF NORTH HAVEN COMMUNITY SERVICES

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 1164513388 NPI number — TOWN OF NORTH HAVEN COMMUNITY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF NORTH HAVEN COMMUNITY SERVICES
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:
NORTH HAVEN COMMUNITY SERVICES
Provider Other Organization Name Type Code:
3
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:
1164513388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/18/2022
NPI Reactivation Date:
04/07/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 CHURCH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-239-5321
Provider Business Mailing Address Fax Number:
203-234-3942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 LINSLEY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-239-5321
Provider Business Practice Location Address Fax Number:
203-234-3942
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FREDA
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
FIRST SELECTMAN
Authorized Official Telephone Number:
203-239-5321

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  C-0008 , 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: CTGA000475 . This is a "DMHAS/ SAGA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010016342CT02 . This is a "ANTHEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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