Provider Demographics
NPI:1518948025
Name:GILEAD COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:GILEAD COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-343-5300
Mailing Address - Street 1:222 MAIN STREET EXT
Mailing Address - Street 2:P.O. BOX 1000
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4406
Mailing Address - Country:US
Mailing Address - Phone:860-343-5300
Mailing Address - Fax:860-343-5306
Practice Address - Street 1:230 MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4470
Practice Address - Country:US
Practice Address - Phone:860-343-5300
Practice Address - Fax:830-343-5306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0543261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004140505Medicaid
CTC01863OtherPTAN