Provider Demographics
NPI:1306401377
Name:RELIANT BEHAVIORAL HEALTH AND COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:RELIANT BEHAVIORAL HEALTH AND COMMUNITY SERVICES LLC
Other - Org Name:EFFECTIVE COMMUNITY SERVICES TLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY-GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-439-5555
Mailing Address - Street 1:73 FERNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-2915
Mailing Address - Country:US
Mailing Address - Phone:203-439-5555
Mailing Address - Fax:203-738-1117
Practice Address - Street 1:419 WHALLEY AVE FL 1
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-439-5555
Practice Address - Fax:203-738-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1306401377Medicaid
CT88-3179675OtherSELF PAY