Provider Demographics
NPI:1114950243
Name:FRANCISCAN LIFE CENTER NETWORK, INCORPORATED
Entity Type:Organization
Organization Name:FRANCISCAN LIFE CENTER NETWORK, INCORPORATED
Other - Org Name:FRANCISCAN LIFE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-237-8084
Mailing Address - Street 1:271 FINCH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2715
Mailing Address - Country:US
Mailing Address - Phone:203-237-8084
Mailing Address - Fax:203-639-1333
Practice Address - Street 1:271 FINCH AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2715
Practice Address - Country:US
Practice Address - Phone:203-237-8084
Practice Address - Fax:203-639-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC-0211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004160941Medicaid
CTC-01560Medicare ID - Type UnspecifiedOUTPATIENT MENTAL HEALTH