Healthcare Provider Details

I. General information

NPI: 1841337284
Provider Name (Legal Business Name): EARLY CHILDHOOD SERVICE - AMERICAN SCHOOL FOR THE DEAF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/21/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 N MAIN ST
WEST HARTFORD CT
06107-1264
US

IV. Provider business mailing address

139 N MAIN ST
WEST HARTFORD CT
06107-1264
US

V. Phone/Fax

Practice location:
  • Phone: 860-570-2347
  • Fax: 860-570-2332
Mailing address:
  • Phone: 860-570-1881
  • Fax: 860-570-2332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY S. BRAVIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 860-570-1816