Provider Demographics
NPI:1225180391
Name:MCCALL FOUNDATION, INC.
Entity Type:Organization
Organization Name:MCCALL FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF QUALITY ASSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:860-496-2100
Mailing Address - Street 1:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-0806
Mailing Address - Country:US
Mailing Address - Phone:860-496-2100
Mailing Address - Fax:860-496-2111
Practice Address - Street 1:127 MIGEON AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-4816
Practice Address - Country:US
Practice Address - Phone:860-496-2100
Practice Address - Fax:860-496-2111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCCALL FOUNDATION. INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-17
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTSA-0057324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004159556Medicaid