Provider Demographics
NPI:1437540176
Name:ANNIE C. COURTNEY FOUNDATION, INC.
Entity Type:Organization
Organization Name:ANNIE C. COURTNEY FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZAN
Authorized Official - Middle Name:MURIELLE
Authorized Official - Last Name:PLOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:475-235-2184
Mailing Address - Street 1:211 SCHRAFFTS DR
Mailing Address - Street 2:A5
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3222
Mailing Address - Country:US
Mailing Address - Phone:475-235-2184
Mailing Address - Fax:
Practice Address - Street 1:211 SCHRAFFTS DR
Practice Address - Street 2:A5
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3222
Practice Address - Country:US
Practice Address - Phone:475-235-2184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT251S00000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency