Provider Demographics
NPI:1407055403
Name:SALVATION ARMY MENS SOCIAL SERVICE
Entity Type:Organization
Organization Name:SALVATION ARMY MENS SOCIAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARC COMMANDER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-732-4111
Mailing Address - Street 1:PO BOX 320440
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06132-0440
Mailing Address - Country:US
Mailing Address - Phone:860-527-8106
Mailing Address - Fax:860-246-8212
Practice Address - Street 1:333 HOMESTEAD AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-2155
Practice Address - Country:US
Practice Address - Phone:860-527-8106
Practice Address - Fax:860-246-8212
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SALVATION ARMY ARC COMMAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTSA-0067324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility