Provider Demographics
NPI:1528820727
Name:SCALZI ORIGINALS FOUNDATION
Entity type:Organization
Organization Name:SCALZI ORIGINALS FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:203-554-9857
Mailing Address - Street 1:34 LOUGHLIN AVE
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2619
Mailing Address - Country:US
Mailing Address - Phone:203-555-9857
Mailing Address - Fax:
Practice Address - Street 1:34 LOUGHLIN AVE
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2619
Practice Address - Country:US
Practice Address - Phone:203-555-9857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health