Provider Demographics
NPI:1831314970
Name:CATHOLIC CHARITIES OF FAIRFIELD COUNTY, INC.
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF FAIRFIELD COUNTY, INC.
Other - Org Name:CATHOLIC CHARITIES - BRIDGEPORT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-416-1307
Mailing Address - Street 1:238 JEWETT AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-2845
Mailing Address - Country:US
Mailing Address - Phone:203-416-1318
Mailing Address - Fax:203-373-0835
Practice Address - Street 1:238 JEWETT AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-2845
Practice Address - Country:US
Practice Address - Phone:203-416-1318
Practice Address - Fax:203-373-0835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040655Medicaid
CT004040655Medicaid