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

Table of content: (NPI 1497849624)

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:
Provider Other Organization Name Type Code:
6
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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