Provider Demographics
NPI:1376677146
Name:CAPITOL REGION EDUCATION COUNCIL
Entity Type:Organization
Organization Name:CAPITOL REGION EDUCATION COUNCIL
Other - Org Name:JOHN J ALLISON POLARIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR STUDENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TARTAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-509-3732
Mailing Address - Street 1:474 SCHOOL STREET
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-1149
Mailing Address - Country:US
Mailing Address - Phone:860-289-8131
Mailing Address - Fax:860-289-0090
Practice Address - Street 1:474 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-1149
Practice Address - Country:US
Practice Address - Phone:860-289-8131
Practice Address - Fax:860-289-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X
CT0413251300000X, 251S00000X, 261Q00000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251300000XAgenciesLocal Education Agency (LEA)
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004250594Medicaid
CT008090417Medicaid
CT0413OtherSCHOOL BASED HEALTH CENTER