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General NPI Number Information
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NPI Number | 1144522160
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Entity Type | Organization
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Legal Business Name | COMMUNITY RENEWAL TEAM INC.
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 675 TOWER AVE
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City | HARTFORD
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State | CT
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Zip | 06451
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Country | US
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Telephone | 860-714-2718
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Fax |
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Provider Business Mailing Address
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Address Line | 675 TOWER AVE
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City | HARTFORD
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State | CT
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Zip | 06112-1273
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Country | US
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Telephone | 860-714-8516
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Fax |
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Authorized Official
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Title or Position | CLINICAL CASE MANAGER
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Name | DEMYS Y MERCADO
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Credential | BA
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Telephone | 860-714-2718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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