Healthcare Provider Details

I. General information

NPI: 1740489434
Provider Name (Legal Business Name): COMMUNITY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 10/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALBANY AVENUE
HARTFORD CT
06120-2508
US

IV. Provider business mailing address

500 ALBANY AVENUE
HARTFORD CT
06120-2508
US

V. Phone/Fax

Practice location:
  • Phone: 860-249-9625
  • Fax:
Mailing address:
  • Phone: 860-249-9625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0293
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0293
License Number StateCT

VIII. Authorized Official

Name: MR. MICHAEL SHERMAN
Title or Position: CEO
Credential:
Phone: 860-808-8701