Basic Information
| Provider Information | |||||||||
| NPI: | 1154415354 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CATHOLIC CHARITIES INC - ARCHDIOCESE OF HARTFORD | ||||||||
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| OtherOrganizationName: | CATHOLIC FAMILY SERVICES - ARCHDIOCESE OF HARTFORD | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 839 ASYLUM AVE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061052801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604931841 | ||||||||
| FaxNumber: | 8605481930 | ||||||||
| Practice Location | |||||||||
| Address1: | 56 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067022103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037551196 | ||||||||
| FaxNumber: | 2035759675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 04/21/2010 | ||||||||
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| AuthorizedOfficialLastName: | SENATORE | ||||||||
| AuthorizedOfficialFirstName: | ROSE ALMA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8604931841 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | B000672 | 01 | CT | CTGA | OTHER | ANC1423 | 01 | CT | OXFORD | OTHER | 77ABH0006CT08 | 01 | CO | BC/BS | OTHER | 183459 | 01 | CO | HEALTH NET/MHN | OTHER | 004040713 | 05 | CT | MEDICAID |