1134407174 NPI number — COMPASSIONATE PSYCHIATRIC CARE, LLC

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 1134407174 NPI number — COMPASSIONATE PSYCHIATRIC CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASSIONATE PSYCHIATRIC CARE, 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:
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:
1134407174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 BOSTON POST RD
Provider Second Line Business Mailing Address:
SECOND FLOOR
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06443-2157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-421-6156
Provider Business Mailing Address Fax Number:
203-421-6157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 BOSTON POST RD
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06443-2157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-421-6156
Provider Business Practice Location Address Fax Number:
203-421-6157
Provider Enumeration Date:
07/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DURIVAGE
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
E
Authorized Official Title or Position:
APRN-BC
Authorized Official Telephone Number:
203-421-6156

Provider Taxonomy Codes

  • Taxonomy code: 364SP0809X , with the licence number:  004454 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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