Organization · NPI-2
/Wayfaring Ministries
Point of Service · Hamden, CT
NPI number1891199931
StatusActive
Last updated in NPPESOct 17, 2014
Details
- NPI
- 1891199931
- Entity type
- Organization (NPI-2)
- Legal business name
- /Wayfaring Ministries
- Organization subpart
- No
- Enumeration date
- Oct 17, 2014
- Last updated
- Oct 17, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 305S00000X | Point of Service | 003563 | CT | Yes |
| 305R00000X | Preferred Provider Organization | 003563 | CT |
Practice location
29r Marne St RearHamden, CT 06514-3628
Phone 203-533-9512 · Fax 203-248-4572
Mailing address
29r Marne St RearHamden, CT 06514-3628
Phone 203-533-9512 · Fax 203-248-4572
Authorized official
Roger Johnson
Administrator
2035339512
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