Provider Demographics
NPI:1114074606
Name:TOWN OF STRATFORD HEALTH DEPT.
Entity Type:Organization
Organization Name:TOWN OF STRATFORD HEALTH DEPT.
Other - Org Name:WOOSTER SCHOOL BASED HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROJECT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRONEILL
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:203-381-6922
Mailing Address - Street 1:150 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4000
Mailing Address - Country:US
Mailing Address - Phone:203-381-6922
Mailing Address - Fax:203-381-6923
Practice Address - Street 1:150 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4000
Practice Address - Country:US
Practice Address - Phone:203-381-6922
Practice Address - Fax:203-381-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD0000X
CT0252261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004144573Medicaid