1801834890 NPI number — SAINT FRANCIS BEHAVIORAL HEALTH GROUP, P.C.

Table of content: (NPI 1801834890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801834890 NPI number — SAINT FRANCIS BEHAVIORAL HEALTH GROUP, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT FRANCIS BEHAVIORAL HEALTH GROUP, P.C.
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:
PATH OUTPATIENT SERVICES
Provider Other Organization Name Type Code:
4
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:
1801834890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
675 TOWER AVE
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06112-1273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-714-2750
Provider Business Mailing Address Fax Number:
860-714-8591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 TOWER AVENUE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06112-1260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-714-2750
Provider Business Practice Location Address Fax Number:
860-714-8591
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIDA
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
860-714-9333

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 004197788 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004255966 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004256013 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50PATHPCICT01 . This is a "ANTHEM BC/BS GROUP #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004245909 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004255891 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004210069 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004210481 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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