Healthcare Provider Details

I. General information

NPI: 1245304096
Provider Name (Legal Business Name): THE VILLAGE FOR FAMILIES & CHILDREN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 02/05/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 ALBANY AVE
HARTFORD CT
06105-1001
US

IV. Provider business mailing address

1680 ALBANY AVENUE ATTN: LINDA RODERICK, BILLING MANAGER
HARTFORD CT
06105-1001
US

V. Phone/Fax

Practice location:
  • Phone: 860-297-0598
  • Fax:
Mailing address:
  • Phone: 860-882-6408
  • Fax: 860-882-6450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberCCF--SH3
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberCCF-RT-44
License Number StateCT

VIII. Authorized Official

Name: HECTOR GLYNN
Title or Position: PRESIDENT AND CEO
Credential: MSW
Phone: 860-236-4511