Provider Demographics
NPI:1033359500
Name:EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF CT, INC.
Entity Type:Organization
Organization Name:EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF CT, INC.
Other - Org Name:KIDSAFE CT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:F
Authorized Official - Last Name:ATWATER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:860-872-1918
Mailing Address - Street 1:19 ELM ST
Mailing Address - Street 2:
Mailing Address - City:VERNON ROCKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3207
Mailing Address - Country:US
Mailing Address - Phone:860-872-1918
Mailing Address - Fax:860-872-8066
Practice Address - Street 1:19 ELM ST
Practice Address - Street 2:
Practice Address - City:VERNON ROCKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06066-3207
Practice Address - Country:US
Practice Address - Phone:860-872-1918
Practice Address - Fax:860-872-8066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health