1700085750 NPI number — BALANCED ENERGY PARTNERSHIP, LLC

Table of content: (NPI 1700085750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700085750 NPI number — BALANCED ENERGY PARTNERSHIP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BALANCED ENERGY PARTNERSHIP, LLC
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:
FAMILY COUNSELING OF CHESHIRE
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:
1700085750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
558 MAPLE AVE STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESHIRE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06410-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-250-9654
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
558 MAPLE AVE STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESHIRE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06410-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-250-9654
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WENT
Authorized Official First Name:
GRETCHEN
Authorized Official Middle Name:
STARK
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
203-464-1249

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 004254207 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004254992 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".