Provider Demographics
NPI:1710185731
Name:WATERFORD COUNTRY SCHOOL, INC.
Entity Type:Organization
Organization Name:WATERFORD COUNTRY SCHOOL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-442-9454
Mailing Address - Street 1:78 HUNTS BROOK RD
Mailing Address - Street 2:
Mailing Address - City:QUAKER HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06375-1009
Mailing Address - Country:US
Mailing Address - Phone:860-442-9454
Mailing Address - Fax:860-440-4340
Practice Address - Street 1:78 HUNTS BROOK RD
Practice Address - Street 2:
Practice Address - City:QUAKER HILL
Practice Address - State:CT
Practice Address - Zip Code:06375-1009
Practice Address - Country:US
Practice Address - Phone:860-442-9454
Practice Address - Fax:860-440-4340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTOPCC-50261QM0855X
CTCCF/RT#12323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health