Provider Demographics
NPI:1972665784
Name:CITY OF HARTFORD
Entity Type:Organization
Organization Name:CITY OF HARTFORD
Other - Org Name:HARTFORD PUBLIC SCHOOLS
Other - Org Type:Other Name
Authorized Official - Title/Position:COORDINATOR OF HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMEIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-695-8780
Mailing Address - Street 1:960 MAIN ST FL 9
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-1218
Mailing Address - Country:US
Mailing Address - Phone:860-695-8852
Mailing Address - Fax:860-722-8095
Practice Address - Street 1:960 MAIN ST UNIT 8
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-1225
Practice Address - Country:US
Practice Address - Phone:860-695-8852
Practice Address - Fax:860-722-8630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT261Q00000X, 261QD0000X
124Q00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Not Answered124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004039152Medicaid
CT004011094Medicaid