Healthcare Provider Details

I. General information

NPI: 1679421119
Provider Name (Legal Business Name): URBAN COMMUNITY ALLIANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446A BLAKE ST STE 200
NEW HAVEN CT
06515-4437
US

IV. Provider business mailing address

446A BLAKE ST STE 200
NEW HAVEN CT
06515-4437
US

V. Phone/Fax

Practice location:
  • Phone: 203-786-5970
  • Fax:
Mailing address:
  • Phone: 203-786-5970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY ELLIS-WEST
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 203-786-5970