Healthcare Provider Details

I. General information

NPI: 1780876839
Provider Name (Legal Business Name): GILEAD COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 HIGH ST
CLINTON CT
06413-1715
US

IV. Provider business mailing address

PO BOX 1000 222 MAIN STREET EXTENSION
MIDDLETOWN CT
06457-1000
US

V. Phone/Fax

Practice location:
  • Phone: 860-669-1632
  • Fax: 860-669-0040
Mailing address:
  • Phone: 860-343-5300
  • Fax: 860-343-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number0042
License Number StateCT

VIII. Authorized Official

Name: MRS. CHRISTINE D LEIBY
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 860-343-5300