Provider Demographics
NPI:1336179480
Name:HOCKANUM VALLEY COMMUNITY COUNCIL, INC.
Entity Type:Organization
Organization Name:HOCKANUM VALLEY COMMUNITY COUNCIL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-872-9825
Mailing Address - Street 1:27 NAEK RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3965
Mailing Address - Country:US
Mailing Address - Phone:860-872-9825
Mailing Address - Fax:860-870-9384
Practice Address - Street 1:27 NAEK RD
Practice Address - Street 2:SUITE 4
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-3965
Practice Address - Country:US
Practice Address - Phone:860-872-9825
Practice Address - Fax:860-870-9384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0466261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01720OtherMEDICARE GROUP
CT004140498Medicaid