1295854776 NPI number — ST. VINCENT'S SPECIAL NEEDS CENTER, INC.

Table of content: (NPI 1295854776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295854776 NPI number — ST. VINCENT'S SPECIAL NEEDS CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. VINCENT'S SPECIAL NEEDS CENTER, 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:
ST. VINCENT'S SPECIAL NEEDS SERVICES
Provider Other Organization Name Type Code:
3
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:
1295854776
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 MERRITT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUMBULL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06611-5435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-375-6400
Provider Business Mailing Address Fax Number:
203-380-1190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 MERRITT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRUMBULL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06611-5435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-375-6400
Provider Business Practice Location Address Fax Number:
203-380-1190
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BALDWIN
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
203-375-6400

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QA3000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 004040028 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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