Provider Demographics
NPI:1396885182
Name:CITY OF STAMFORD, DHSS
Entity type:Organization
Organization Name:CITY OF STAMFORD, DHSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:FOUNTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:203-977-4936
Mailing Address - Street 1:888 WASHINGTON BLVD
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-2902
Mailing Address - Country:US
Mailing Address - Phone:203-977-5662
Mailing Address - Fax:
Practice Address - Street 1:19 HORTON ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-6216
Practice Address - Country:US
Practice Address - Phone:203-977-6691
Practice Address - Fax:203-977-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0389261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental