| Charter Oak Health Center, Inc. | |
|
21 Grand St Hartford CT 06106-1541 | |
| (860) 550-7500 | |
| (860) 550-7501 |
| Full Name | Charter Oak Health Center, Inc. |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 21 Grand St, Hartford, Connecticut |
| Authorized Official Name and Position | Tim Powers (CHIEF COMPLIANCE OFFICER) |
| Authorized Official Contact | 8605507500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Charter Oak Health Center, Inc. 21 Grand St Hartford CT 06106-1541 Ph: (860) 550-7500 | Charter Oak Health Center, Inc. 21 Grand St Hartford CT 06106-1541 Ph: (860) 550-7500 |
| NPI Number | 1134245350 |
|---|---|
| Provider Enumeration Date | 03/21/2007 |
| Last Update Date | 04/30/2024 |
| Certification Date | 04/23/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134245350 | NPI | - | NPPES |
| 004236015 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 0312 (Connecticut) | Primary |
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