Provider Demographics
NPI:1164513388
Name:TOWN OF NORTH HAVEN COMMUNITY SERVICES
Entity Type:Organization
Organization Name:TOWN OF NORTH HAVEN COMMUNITY SERVICES
Other - Org Name:NORTH HAVEN COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRST SELECTMAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FREDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-239-5321
Mailing Address - Street 1:18 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473
Mailing Address - Country:US
Mailing Address - Phone:203-239-5321
Mailing Address - Fax:203-234-3942
Practice Address - Street 1:5 LINSLEY STREET
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473
Practice Address - Country:US
Practice Address - Phone:203-239-5321
Practice Address - Fax:203-234-3942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2022-04-20
Deactivation Date:2022-02-18
Deactivation Code:
Reactivation Date:2022-04-07
Provider Licenses
StateLicense IDTaxonomies
CTC-0008261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCTGA000475OtherDMHAS/ SAGA
CT010016342CT02OtherANTHEM
CT010016342CT02OtherANTHEM