Provider Demographics
NPI:1487846044
Name:GILEAD COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:GILEAD COMMUNITY SERVICES, INC.
Other - Org Name:GILEADI
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEIBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-343-5300
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:222 MAIN STREET EXTENSION
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1000
Mailing Address - Country:US
Mailing Address - Phone:860-343-5300
Mailing Address - Fax:860-343-5306
Practice Address - Street 1:453 HIGH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-2612
Practice Address - Country:US
Practice Address - Phone:860-343-5315
Practice Address - Fax:860-343-6139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTRLC-0003323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004246692Medicaid