Provider Demographics
NPI:1780865998
Name:MANCHESTER HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:MANCHESTER HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERNIAK-LEXIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-647-3173
Mailing Address - Street 1:479 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4101
Mailing Address - Country:US
Mailing Address - Phone:860-647-3173
Mailing Address - Fax:860-647-3188
Practice Address - Street 1:479 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4101
Practice Address - Country:US
Practice Address - Phone:860-647-3173
Practice Address - Fax:860-647-3188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare