Provider Demographics
NPI:1548419039
Name:HALL-BROOKE BEHAVIORAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:HALL-BROOKE BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCREATH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-221-8801
Mailing Address - Street 1:47 LONG LOTS RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3828
Mailing Address - Country:US
Mailing Address - Phone:203-221-8801
Mailing Address - Fax:
Practice Address - Street 1:47 LONG LOTS RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3828
Practice Address - Country:US
Practice Address - Phone:203-221-8801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2009-02-11
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
CTC-00051OtherMEDICARE GROUP
CT07-4611OtherMEDICARE PART B
CT008002612Medicaid