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General NPI Number Information
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NPI Number | 1013061209
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Entity Type | Organization
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Legal Business Name | STATE OF CT. - OFFICE OF THE COMPTROLLER
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 03/28/2016
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Provider Practice Location Address
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Address Line | 300 ARMORY RD
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City | STRATFORD
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State | CT
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Zip | 06614-1752
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Country | US
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Telephone | 203-579-6906
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Fax |
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Provider Business Mailing Address
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Address Line | 300 ARMORY RD
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City | STRATFORD
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State | CT
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Zip | 06614-1752
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Country | US
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Telephone | 203-579-6906
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Fax |
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Authorized Official
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Title or Position | FISCAL ADMINISTRATOR
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Name | MR. CRESCENTINO SECCHIAROLI
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Credential |
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Telephone | 860-418-8712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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