Provider Demographics
NPI:1255535357
Name:TVCCA SENIOR NUTRITION PROGRAM
Entity type:Organization
Organization Name:TVCCA SENIOR NUTRITION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRILLS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:860-885-2745
Mailing Address - Street 1:81 STOCKHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BOZRAH
Mailing Address - State:CT
Mailing Address - Zip Code:06334-1121
Mailing Address - Country:US
Mailing Address - Phone:860-885-2745
Mailing Address - Fax:860-892-2295
Practice Address - Street 1:81 STOCKHOUSE RD
Practice Address - Street 2:
Practice Address - City:BOZRAH
Practice Address - State:CT
Practice Address - Zip Code:06334-1121
Practice Address - Country:US
Practice Address - Phone:860-885-2745
Practice Address - Fax:860-892-2295
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THAMES VALLEY COUNCIL FOR COMMUNITY ACTION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-13
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals