Provider Demographics
NPI:1689081085
Name:PRENATAL CLINIC
Entity Type:Organization
Organization Name:PRENATAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE/CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-456-6821
Mailing Address - Street 1:PO BOX 4131
Mailing Address - Street 2:
Mailing Address - City:YALESVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1481
Mailing Address - Country:US
Mailing Address - Phone:203-284-1340
Mailing Address - Fax:203-265-4557
Practice Address - Street 1:112 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2045
Practice Address - Country:US
Practice Address - Phone:860-456-6821
Practice Address - Fax:203-265-4557
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINDHAM COMMUNITY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0061282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
HOSPITAL LICENSE NUMOther0061