Provider Demographics
NPI:1710216163
Name:THE CHILDREN'S HOME
Entity type:Organization
Organization Name:THE CHILDREN'S HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-635-6010
Mailing Address - Street 1:58 MISSIONARY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416
Mailing Address - Country:US
Mailing Address - Phone:860-635-6010
Mailing Address - Fax:860-613-3926
Practice Address - Street 1:58 MISSIONARY RD
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2134
Practice Address - Country:US
Practice Address - Phone:860-635-6010
Practice Address - Fax:860-613-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children