=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144952276
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUR PIECE OF THE PIE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2022
-----------------------------------------------------
Last Update Date | 06/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20-28 SARGEANT ST
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06105-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-761-7300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20-28 SARGEANT ST
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06105-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-761-7300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | HECTOR RIVERA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-761-7343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------