1225097231 NPI number — STONINGTON BEHAVIORAL HEALTH INC

Table of content: (NPI 1225097231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225097231 NPI number — STONINGTON BEHAVIORAL HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STONINGTON BEHAVIORAL HEALTH 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:
1225097231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 SWANTOWN HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH STONINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06359-1022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-439-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 SWANTOWN HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH STONINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06359-1022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-439-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FILTON
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO SR VP
Authorized Official Telephone Number:
610-768-3300

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  0071 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283Q00000X , with the licence number: 0071 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 324500000X , with the licence number: 0071 , 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: 004245420 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004260791 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004245438 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004253605 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004260767 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004260775 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004260783 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".