Provider Demographics
NPI:1386853182
Name:TOWN OF STRATFORD
Entity Type:Organization
Organization Name:TOWN OF STRATFORD
Other - Org Name:STRATFORD HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOISSEVAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:203-385-4090
Mailing Address - Street 1:468 BIRDSEYE ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-6976
Mailing Address - Country:US
Mailing Address - Phone:203-385-4090
Mailing Address - Fax:203-381-2048
Practice Address - Street 1:468 BIRDSEYE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-6976
Practice Address - Country:US
Practice Address - Phone:203-385-4090
Practice Address - Fax:203-381-2048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004062162Medicaid
CT68VNA0021CT01OtherANTHEM
CT68VNA0021CT01OtherANTHEM
CT2V5235OtherHEALTHNET