Healthcare Provider Details

I. General information

NPI: 1134956071
Provider Name (Legal Business Name): DEMALIAS HOUSE OF HOPE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 EASY ST
PLAINFIELD CT
06374-1144
US

IV. Provider business mailing address

15 EASY ST
PLAINFIELD CT
06374-1144
US

V. Phone/Fax

Practice location:
  • Phone: 774-312-3881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierCDP00932
Identifier TypeOTHER
Identifier StateRI
Identifier IssuerDEPARTMENT OF HEALTH

VIII. Authorized Official

Name: ANDREW DEMALIA
Title or Position: PRESIDENT, CEO
Credential:
Phone: 774-312-3881