| Charter Oak Family Center Llc | |
|
843 Main St Ste 11 Manchester CT 06040-6041 | |
| (860) 643-8870 | |
| Not Available |
| Full Name | Charter Oak Family Center Llc |
|---|---|
| Speciality | Social Worker |
| Location | 843 Main St Ste 11, Manchester, Connecticut |
| Authorized Official Name and Position | Stephen R Machattie (CEO) |
| Authorized Official Contact | 8606438870 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charter Oak Family Center Llc 843 Main St Ste 11 Manchester CT 06040-6041 Ph: (860) 643-8870 | Charter Oak Family Center Llc 843 Main St Ste 11 Manchester CT 06040-6041 Ph: (860) 643-8870 |
| NPI Number | 1538622618 |
|---|---|
| Provider Enumeration Date | 04/07/2019 |
| Last Update Date | 08/29/2023 |
| Certification Date | 08/29/2023 |
| Medicare PECOS PAC ID | 4082957014 |
|---|---|
| Medicare Enrollment ID | O20190515001176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538622618 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Stephan Machattie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306217765 PECOS PAC ID: 0143508671 Enrollment ID: I20161103000500 |
| Provider Name | Kaci Courtemanche |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669930426 PECOS PAC ID: 1355705500 Enrollment ID: I20230907000338 |
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