Provider Demographics
NPI:1922568914
Name:BAGS FOUNDATION CT INC
Entity Type:Organization
Organization Name:BAGS FOUNDATION CT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NAKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-591-1182
Mailing Address - Street 1:135 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1301
Mailing Address - Country:US
Mailing Address - Phone:203-591-1182
Mailing Address - Fax:203-591-1181
Practice Address - Street 1:135 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1301
Practice Address - Country:US
Practice Address - Phone:203-591-1182
Practice Address - Fax:203-591-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty