Basic Information
| Provider Information | |||||||||
| NPI: | 1245304096 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE VILLAGE FOR FAMILIES & CHILDREN, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1680 ALBANY AVE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602970598 | ||||||||
| FaxNumber: | 8602337751 | ||||||||
| Practice Location | |||||||||
| Address1: | 1680 ALBANY AVE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602970598 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | GALO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 8602970598 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MPH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | CCF--SH3 | CT | X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 323P00000X | CCF-RT-44 | CT | X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |
No ID Information.