1972665784 NPI number — CITY OF HARTFORD

Table of content: (NPI 1972665784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972665784 NPI number — CITY OF HARTFORD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY 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:
HARTFORD PUBLIC SCHOOLS
Provider Other Organization Name Type Code:
5
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:
1972665784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
960 MAIN ST FL 9
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:
06103-1218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-695-8852
Provider Business Mailing Address Fax Number:
860-722-8095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 MAIN ST UNIT 8
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:
06103-1225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-695-8852
Provider Business Practice Location Address Fax Number:
860-722-8630
Provider Enumeration Date:
12/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHAMEIDES
Authorized Official First Name:
DEBBIE
Authorized Official Middle Name:
Authorized Official Title or Position:
COORDINATOR OF HEALTH SERVICES
Authorized Official Telephone Number:
860-695-8780

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD0000X , 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: 004039152 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004011094 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".