1245304096 NPI number — THE VILLAGE FOR FAMILIES & CHILDREN, INC.

Table of content: (NPI 1245304096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245304096 NPI number — THE VILLAGE FOR FAMILIES & CHILDREN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE VILLAGE FOR FAMILIES & CHILDREN, 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:
1245304096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1680 ALBANY AVENUE
Provider Second Line Business Mailing Address:
ATTN: LINDA RODERICK, BILLING MANAGER
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06105-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-882-6408
Provider Business Mailing Address Fax Number:
860-882-6450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1680 ALBANY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06105-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-297-0598
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GLYNN
Authorized Official First Name:
HECTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
860-236-4511

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  CCF--SH3 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 323P00000X , with the licence number: CCF-RT-44 , 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)

  • Identifier: 004040622 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004255338 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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