1316158256 NPI number — CHEMICAL ABUSE SERVICES AGENCY, INC.

Table of content: (NPI 1316158256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316158256 NPI number — CHEMICAL ABUSE SERVICES AGENCY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEMICAL ABUSE SERVICES AGENCY, 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:
PROJECT COURAGE
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:
1316158256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1124 IRANISTAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06605-1121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-331-4728
Provider Business Mailing Address Fax Number:
203-873-0987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
592 KOSSUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06608-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-339-4777
Provider Business Practice Location Address Fax Number:
203-339-4110
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DELERME
Authorized Official First Name:
ASHER
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
203-331-4728

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  SA-0139 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X , with the licence number: 0139 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 004175528 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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