Provider Demographics
NPI:1417143504
Name:HOUSATONIC VALLEY HEALTH DISTRICT
Entity Type:Organization
Organization Name:HOUSATONIC VALLEY HEALTH DISTRICT
Other - Org Name:HOUSATONIC VALLEY HEALTH DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HEALTH
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BETHGE
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:203-264-9616
Mailing Address - Street 1:77 MAIN STREET NORTH
Mailing Address - Street 2:SUITE #205
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488
Mailing Address - Country:US
Mailing Address - Phone:203-264-9616
Mailing Address - Fax:203-262-1960
Practice Address - Street 1:77 MAIN STREET NORTH
Practice Address - Street 2:SUITE #205
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2200
Practice Address - Country:US
Practice Address - Phone:203-264-9616
Practice Address - Fax:203-262-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0939261QC1500X
261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V5218OtherHEALTHNET
CT899051OtherCONNECTICARE
CT68 VNA0071CT01OtherANTHEM B.C. & B.S.
CT2V5218OtherHEALTHNET