Provider Demographics
NPI:1174828222
Name:FAMILY AFFIRMATION CENTER FOR TREATMENT
Entity Type:Organization
Organization Name:FAMILY AFFIRMATION CENTER FOR TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGARE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-896-5331
Mailing Address - Street 1:281 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4784
Mailing Address - Country:US
Mailing Address - Phone:860-896-5331
Mailing Address - Fax:
Practice Address - Street 1:281 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4784
Practice Address - Country:US
Practice Address - Phone:860-896-5331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health