Provider Demographics
NPI:1710004098
Name:THE KENNEDY COLLECTIVE, INC.
Entity Type:Organization
Organization Name:THE KENNEDY COLLECTIVE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEBASTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-365-8522
Mailing Address - Street 1:2440 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4735
Mailing Address - Country:US
Mailing Address - Phone:203-332-4535
Mailing Address - Fax:203-332-4539
Practice Address - Street 1:2440 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4735
Practice Address - Country:US
Practice Address - Phone:203-365-8522
Practice Address - Fax:203-365-8533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004186054Medicaid