Provider Demographics
NPI:1962601740
Name:YOUTH CHALLENGE OF CONNECTICUT, INC.
Entity type:Organization
Organization Name:YOUTH CHALLENGE OF CONNECTICUT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:860-728-5199
Mailing Address - Street 1:15-17 MAY STREET
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1519
Mailing Address - Country:US
Mailing Address - Phone:860-728-5199
Mailing Address - Fax:860-524-0418
Practice Address - Street 1:15-17-19 MAY STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1519
Practice Address - Country:US
Practice Address - Phone:860-728-5199
Practice Address - Fax:860-524-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTSA0065324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility