Provider Demographics
NPI:1942649033
Name:CAPITOL REGION MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:CAPITOL REGION MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-297-0910
Mailing Address - Street 1:500 VINE STREET
Mailing Address - Street 2:CAPITOL REGION MENTAL HEALTH CENTER- PHARMACY
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112
Mailing Address - Country:US
Mailing Address - Phone:860-297-0910
Mailing Address - Fax:860-297-0967
Practice Address - Street 1:500 VINE STREET
Practice Address - Street 2:CAPITOL REGION MENTAL HEALTH CENTER PHARMACY
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112
Practice Address - Country:US
Practice Address - Phone:860-297-0910
Practice Address - Fax:860-297-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13342283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital