Provider Demographics
NPI:1225247224
Name:CHEMICAL ABUSE SERVICES AGENCY, INC.
Entity Type:Organization
Organization Name:CHEMICAL ABUSE SERVICES AGENCY, INC.
Other - Org Name:CASA EUGENIO MARIA DE HOSTOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DELERME
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LADC, CCS, CCDP
Authorized Official - Phone:203-339-4112
Mailing Address - Street 1:1124 IRANISTAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1121
Mailing Address - Country:US
Mailing Address - Phone:203-331-4728
Mailing Address - Fax:203-873-0987
Practice Address - Street 1:690 ARCTIC ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06608-2008
Practice Address - Country:US
Practice Address - Phone:203-339-4112
Practice Address - Fax:203-339-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTSA-0081251S00000X
CT0452261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004112918Medicaid