Provider Demographics
NPI:1578265179
Name:CENTRAL CONNECTICUT HEALTH DISTRICT
Entity Type:Organization
Organization Name:CENTRAL CONNECTICUT HEALTH DISTRICT
Other - Org Name:CENTRAL CT HEALTH DISTRICT CLINICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-785-8530
Mailing Address - Street 1:2080 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2362
Mailing Address - Country:US
Mailing Address - Phone:860-785-8380
Mailing Address - Fax:860-785-8533
Practice Address - Street 1:506 CROMWELL AVE STE 202
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1851
Practice Address - Country:US
Practice Address - Phone:860-785-8530
Practice Address - Fax:860-785-8533
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL CT HEALTH DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-20
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health