Provider Demographics
NPI:1235404385
Name:UCONN HEALTH CENTER
Entity Type:Organization
Organization Name:UCONN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HOMECARE PROGRAM
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:1860-679-4089
Mailing Address - Street 1:263 FARMINGTON AVE # MC2103
Mailing Address - Street 2:ROOM # C1357
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2103
Mailing Address - Country:US
Mailing Address - Phone:860-480-6501
Mailing Address - Fax:860-679-4077
Practice Address - Street 1:263 FARMINGTON AVE # MC2103
Practice Address - Street 2:ROOM # C1357
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-2103
Practice Address - Country:US
Practice Address - Phone:860-480-6501
Practice Address - Fax:860-679-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004916251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health