Healthcare Provider Details

I. General information

NPI: 1699406355
Provider Name (Legal Business Name): CONNECTICUT HARM REDUCTION ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 ALBANY AVE
HARTFORD CT
06112-2302
US

IV. Provider business mailing address

28 GRAND ST
HARTFORD CT
06106-1506
US

V. Phone/Fax

Practice location:
  • Phone: 860-263-8720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK JENKINS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 860-250-4146