1497849624 NPI number — CATHOLIC CHARITIES, INC. - ARCHDIOCESE OF HARTFORD

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 1497849624 NPI number — CATHOLIC CHARITIES, INC. - ARCHDIOCESE OF HARTFORD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHOLIC CHARITIES, INC. - ARCHDIOCESE OF HARTFORD
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:
CATHOLIC FAMILY SERVICES, INC. - ARCHDIOCESE OF HARTFORD
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:
1497849624
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
839 ASYLUM AVE.,
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-493-1841
Provider Business Mailing Address Fax Number:
860-548-1930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 WAKELEE AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANSONIA
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-493-1841
Provider Business Practice Location Address Fax Number:
869-548-1930
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KUKULKA
Authorized Official First Name:
MAREK
Authorized Official Middle Name:
KRZYSTOF
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
860-728-2566

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004040978 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 183459 . This is a "HEALTHNET/MHN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 77ABH0007CT . This is a "BC/BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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