1568890010 NPI number — CHILDREN'S ACADEMY CT, INC.

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 1568890010 NPI number — CHILDREN'S ACADEMY CT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S ACADEMY CT, 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:
1568890010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 HIGH RIDGE ROAD
Provider Second Line Business Mailing Address:
UNIT 258
Provider Business Mailing Address City Name:
STAMFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-374-2601
Provider Business Mailing Address Fax Number:
203-406-7753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 HIGH RIDGE ROAD
Provider Second Line Business Practice Location Address:
UNIT 258
Provider Business Practice Location Address City Name:
STAMFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-374-2601
Provider Business Practice Location Address Fax Number:
203-406-7753
Provider Enumeration Date:
10/20/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALBONE
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
SCHOOL PSYCHOLOGIST
Authorized Official Telephone Number:
914-374-2601

Provider Taxonomy Codes

  • Taxonomy code: 101YS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 9722695497 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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