=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366999898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSOCIATION OF RELIGIOUS COMMUNITIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2016
-----------------------------------------------------
Last Update Date | 09/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 MAIN STREET
-----------------------------------------------------
City | DANBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-792-9450
-----------------------------------------------------
Fax | 203-792-9452
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 MAIN STREET
-----------------------------------------------------
City | DANBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-792-9450
-----------------------------------------------------
Fax | 203-792-9452
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | PHYLLIS LEOPOLD
-----------------------------------------------------
Credential | REVEREND
-----------------------------------------------------
Telephone | 203-792-9450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------