MEDICARE: CHARTER OAK HEALTH CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	00000259	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003078734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARTER OAK HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	21 GRAND ST
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06106-1541
Country	:	US
Telephone Number	:	860-550-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 MAIN ST
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06106-1806
Country	:	US
Telephone Number	:	860-550-7500
Fax Number	:

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	TIM POWERS
Credential	:
Telephone Number	:	860-550-7500

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	04/07/2026

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