Provider Demographics
NPI:1831462514
Name:GARNER CORRECTIONAL INSTITUTION
Entity Type:Organization
Organization Name:GARNER CORRECTIONAL INSTITUTION
Other - Org Name:CORRECTIONAL MANAGED HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF, CMHC
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-679-5589
Mailing Address - Street 1:50 NUNNAWAUK RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2319
Mailing Address - Country:US
Mailing Address - Phone:203-270-2608
Mailing Address - Fax:
Practice Address - Street 1:50 NUNNAWAUK RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-2319
Practice Address - Country:US
Practice Address - Phone:203-270-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-11
Last Update Date:2012-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021797302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization