Provider Demographics
NPI:1013107432
Name:HOGAR CREA INTERNATIONAL OF CONNECTICUT, INC.
Entity type:Organization
Organization Name:HOGAR CREA INTERNATIONAL OF CONNECTICUT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-232-7353
Mailing Address - Street 1:18 NEW PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2122
Mailing Address - Country:US
Mailing Address - Phone:860-232-7353
Mailing Address - Fax:860-233-4733
Practice Address - Street 1:18 NEW PARK AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2122
Practice Address - Country:US
Practice Address - Phone:860-232-7353
Practice Address - Fax:860-233-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTSA0129324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility