| NPI | 1215923131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUGENE A MARKET CEO 860-610-6131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: CT 0265) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: CT 0724) |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: CT 0502) | |
| 261QD0000X Clinic/Center Dental (Licence: CT 0265) | |
| 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: CT 0724) | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: CT 0724) | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: CT 0502) | |
| 261QM0850X Clinic/Center Adult Mental Health (Licence: CT 0724) | |
| 261QP1100X Clinic/Center Podiatric (Licence: CT 0724) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2017-02-07 |