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General NPI Number Information
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NPI Number | 1053785832
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Entity Type | Organization
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Legal Business Name | CHARTER OAK HEALTH CENTER
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Dates
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Enumeration Date | 11/17/2015
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 21 GRAND ST
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City | HARTFORD
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State | CT
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Zip | 06106-1541
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Country | US
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Telephone | 860-550-7500
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Fax | 860-550-7529
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Provider Business Mailing Address
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Address Line | 21 GRAND ST
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City | HARTFORD
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State | CT
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Zip | 06106-1541
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Country | US
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Telephone | 860-550-7500
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Fax | 860-550-7529
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Authorized Official
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Title or Position | INTERIM CFO
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Name | SHANNON P. DONAHUE
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Credential |
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Telephone | 860-550-7524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 0312
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License Number State | CT
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