Provider Demographics
NPI:1497849624
Name:CATHOLIC CHARITIES, INC. - ARCHDIOCESE OF HARTFORD
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES, INC. - ARCHDIOCESE OF HARTFORD
Other - Org Name:CATHOLIC FAMILY SERVICES, INC. - ARCHDIOCESE OF HARTFORD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAREK
Authorized Official - Middle Name:KRZYSTOF
Authorized Official - Last Name:KUKULKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-728-2566
Mailing Address - Street 1:839 ASYLUM AVE.,
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105
Mailing Address - Country:US
Mailing Address - Phone:860-493-1841
Mailing Address - Fax:860-548-1930
Practice Address - Street 1:205 WAKELEE AVE.
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401
Practice Address - Country:US
Practice Address - Phone:860-493-1841
Practice Address - Fax:869-548-1930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040978Medicaid
CO183459OtherHEALTHNET/MHN
CT77ABH0007CTOtherBC/BS
CO183459OtherHEALTHNET/MHN