Provider Demographics
NPI:1174677421
Name:STATE OF CT. - OFFICE OF THE COMPTROLLER
Entity Type:Organization
Organization Name:STATE OF CT. - OFFICE OF THE COMPTROLLER
Other - Org Name:NORTH REGION - RICHARD HOUSE- 85 MTN. RD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRESCENTINO
Authorized Official - Middle Name:
Authorized Official - Last Name:SECCHIAROLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-418-8712
Mailing Address - Street 1:71 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-1508
Mailing Address - Country:US
Mailing Address - Phone:860-331-2024
Mailing Address - Fax:
Practice Address - Street 1:71 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-1508
Practice Address - Country:US
Practice Address - Phone:860-331-2024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006722094Medicaid