1225042542 NPI number — THE CHILDREN'S CENTER OF HAMDEN, INC.

Table of content: (NPI 1225042542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225042542 NPI number — THE CHILDREN'S CENTER OF HAMDEN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHILDREN'S CENTER OF HAMDEN, 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:
1225042542
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 WHITNEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06517-2426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-248-2116
Provider Business Mailing Address Fax Number:
203-287-9815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 WHITNEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06517-2426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-248-2116
Provider Business Practice Location Address Fax Number:
203-287-9815
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOCKERY
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
203-248-2116

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , with the licence number:  EDT-1 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , with the licence number: OPCC-51 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: SA-0093 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: CCF/RT-2 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 323P00000X , with the licence number: CCF/RT-73 , 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: 004254166 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004040846 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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