=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881839025
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARK OF CHRIST MINISTRIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2008
-----------------------------------------------------
Last Update Date | 12/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 WILMOT AVE
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-691-0250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 495 JANE ST
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-691-0250
-----------------------------------------------------
Fax | 203-610-8749
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. GLORIA KABARI SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-691-0250
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0953349
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------