=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083750343
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL NAUGATUCK VALLEY HELP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 ARCH ST
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06710-1901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-597-9008
-----------------------------------------------------
Fax | 203-573-9976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 WATERTOWN AVE
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06708-2011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-756-8984
-----------------------------------------------------
Fax | 203-756-8984
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. ROBERTA MURTAGH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-756-8984
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | CR0003
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------