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General NPI Number Information
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NPI Number | 1437540176
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Entity Type | Organization
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Legal Business Name | ANNIE C. COURTNEY FOUNDATION, INC.
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Dates
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Enumeration Date | 02/17/2015
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 211 SCHRAFFTS DR A5
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City | WATERBURY
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State | CT
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Zip | 06705-3222
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Country | US
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Telephone | 475-235-2184
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Fax |
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Provider Business Mailing Address
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Address Line | 211 SCHRAFFTS DR A5
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City | WATERBURY
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State | CT
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Zip | 06705-3222
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Country | US
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Telephone | 475-235-2184
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | SUZAN MURIELLE PLOWMAN
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Credential |
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Telephone | 475-235-2184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | CT
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