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General NPI Number Information
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NPI Number | 1255735577
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Entity Type | Organization
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Legal Business Name | PIVOT MINISTRIES, INC.
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 485 JANE ST
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City | BRIDGEPORT
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State | CT
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Zip | 06608-1707
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Country | US
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Telephone | 203-336-9263
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Fax | 203-610-6765
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Provider Business Mailing Address
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Address Line | 485 JANE ST
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City | BRIDGEPORT
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State | CT
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Zip | 06608-1707
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Country | US
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Telephone | 203-336-9263
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Fax | 203-610-6765
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TONY KINIRY
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Credential |
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Telephone | 203-336-9263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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