Provider Demographics
NPI:1063639979
Name:TOWN OF ENFIELD
Entity Type:Organization
Organization Name:TOWN OF ENFIELD
Other - Org Name:ENFIELD ADULT DAY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:TOWN MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:W
Authorized Official - Last Name:COPPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-253-6352
Mailing Address - Street 1:1A BEECH RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4462
Mailing Address - Country:US
Mailing Address - Phone:860-763-7538
Mailing Address - Fax:860-763-7584
Practice Address - Street 1:1A BEECH RD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4462
Practice Address - Country:US
Practice Address - Phone:860-763-7538
Practice Address - Fax:860-763-7584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004EADC082OtherCCCI PROVIDER #