Basic Information
| Provider Information | |||||||||
| NPI: | 1841362795 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE VILLAGE FOR FAMILIES & CHILDREN, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1680 ALBANY AVENUE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602364511 | ||||||||
| FaxNumber: | 8602970591 | ||||||||
| Practice Location | |||||||||
| Address1: | 1680 ALBANY AVENUE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602364511 | ||||||||
| FaxNumber: | 8602970591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | GALO | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8602364511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MPH | ||||||||
| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0850X | SA-0218 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0850X | SA-0219 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0850X | C-0091 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0850X | C-0357 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0850X | SA-0285 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | EDT-8 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0855X | EDT-8Q | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0855X | OPCC-16 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0855X | SA-0218 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0855X | SA-0219 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0855X | CCF-TS-52 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0855X | SA-0285 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0855X | CT | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 004040622 | 05 | CT | MEDICAID | 004255338 | 05 | CT | MEDICAID |