Provider Demographics
NPI:1144428145
Name:YOUTH CHALLENGE MISSION FOR WOMEN
Entity Type:Organization
Organization Name:YOUTH CHALLENGE MISSION FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:860-728-5199
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06142-0763
Mailing Address - Country:US
Mailing Address - Phone:860-527-2000
Mailing Address - Fax:860-525-5790
Practice Address - Street 1:32 ATWOOD ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1801
Practice Address - Country:US
Practice Address - Phone:860-527-2000
Practice Address - Fax:860-525-5790
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUTH CHALLENGE OF CONNECTICUT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTSA0117324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility