Organization · NPI-2

Boys And Girls Village

Community/Behavioral Health · Bridgeport, CT

NPI number1497295208
StatusActive
Last updated in NPPESFeb 27, 2017

Details

NPI
1497295208
Entity type
Organization (NPI-2)
Legal business name
Boys And Girls Village
Organization subpart
No
Enumeration date
Feb 27, 2017
Last updated
Feb 27, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
251S00000X Community/Behavioral Health––Yes

Practice location

170 Bennett St
Bridgeport, CT 06605-2901

Phone 203-330-6790

Mailing address

528 Wheelers Farms Rd
Milford, CT 06461-1847

Phone 203-877-0300

Authorized official

Kevin G. Berry
Clinician
4754146105

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