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General NPI Number Information
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NPI Number | 1407055403
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Entity Type | Organization
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Legal Business Name | SALVATION ARMY MENS SOCIAL SERVICE
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 333 HOMESTEAD AVE
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City | HARTFORD
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State | CT
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Zip | 06112-2155
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Country | US
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Telephone | 860-527-8106
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Fax | 860-246-8212
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Provider Business Mailing Address
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Address Line | PO BOX 320440
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City | HARTFORD
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State | CT
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Zip | 06132-0440
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Country | US
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Telephone | 860-527-8106
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Fax | 860-246-8212
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Authorized Official
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Title or Position | ARC COMMANDER
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Name | TIMOTHY A RAINES
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Credential |
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Telephone | 845-732-4111
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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 | SA-0067
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License Number State | CT
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