Healthcare Provider Details

I. General information

NPI: 1790743037
Provider Name (Legal Business Name): BRISTOL-BURLINGTON HEALTH DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 STAFFORD AVE
BRISTOL CT
06010-4682
US

IV. Provider business mailing address

240 STAFFORD AVE
BRISTOL CT
06010-4682
US

V. Phone/Fax

Practice location:
  • Phone: 860-584-7682
  • Fax: 860-584-3814
Mailing address:
  • Phone: 860-584-7682
  • Fax: 860-584-3814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES I. MOTES
Title or Position: DIRECTOR OF HEALTH
Credential: MS, MPH, RS
Phone: 860-584-7682