Healthcare Provider Details

I. General information

NPI: 1487637724
Provider Name (Legal Business Name): COMMUNITY SUBSTANCE ABUSE CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FISHFRY ST
HARTFORD CT
06120-1203
US

IV. Provider business mailing address

1720 LAKEPOINTE DR STE 117
LEWISVILLE TX
75057-6425
US

V. Phone/Fax

Practice location:
  • Phone: 860-247-8300
  • Fax: 860-548-7325
Mailing address:
  • Phone: 214-379-3300
  • Fax: 214-853-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRUCE JARVIE
Title or Position: VP, TREASURER
Credential:
Phone: 214-379-3300