Provider Demographics
NPI:1841362795
Name:THE VILLAGE FOR FAMILIES & CHILDREN, INC.
Entity type:Organization
Organization Name:THE VILLAGE FOR FAMILIES & CHILDREN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:860-236-4511
Mailing Address - Street 1:1680 ALBANY AVENUE
Mailing Address - Street 2:ATTN: LINDA RODERICK, BILLING MANAGER
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1001
Mailing Address - Country:US
Mailing Address - Phone:860-882-6408
Mailing Address - Fax:860-882-6450
Practice Address - Street 1:1680 ALBANY AVENUE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1001
Practice Address - Country:US
Practice Address - Phone:860-236-4511
Practice Address - Fax:860-297-0591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT261QM0801X, 261QM0855X
CTSA-0218261QM0850X, 261QM0855X
CTSA-0219261QM0850X, 261QM0855X
CTC-0091261QM0850X
CTC-0357261QM0850X
CTSA-0285261QM0850X, 261QM0855X
CTEDT-8261QM0855X
CTEDT-8Q261QM0855X
CTOPCC-16261QM0855X
CTCCF-TS-52261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040622Medicaid
CT004255338Medicaid
CTC000794Medicare ID - Type UnspecifiedMEDICARE GROUP#