Provider Demographics
NPI:1407038979
Name:THE CONNECTICUT INSTITUTE FOR THE BLIND/OAK HILL
Entity Type:Organization
Organization Name:THE CONNECTICUT INSTITUTE FOR THE BLIND/OAK HILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:PONT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:860-286-3161
Mailing Address - Street 1:120 HOLCOMB ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1529
Mailing Address - Country:US
Mailing Address - Phone:860-286-3161
Mailing Address - Fax:860-286-3169
Practice Address - Street 1:120 HOLCOMB ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1529
Practice Address - Country:US
Practice Address - Phone:860-286-3161
Practice Address - Fax:860-286-3169
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CONNECTICUT SCHOOL FOR THE BLIND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-27
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT68BTD3044CT01OtherANTHEM BLUE CROSS & BLUE SHIELD