Provider Demographics
NPI:1053613752
Name:COMMUNITY RENEWAL TEAM
Entity type:Organization
Organization Name:COMMUNITY RENEWAL TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL CASE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:860-714-3340
Mailing Address - Street 1:675 TOWER AVE
Mailing Address - Street 2:303
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1273
Mailing Address - Country:US
Mailing Address - Phone:860-714-3340
Mailing Address - Fax:860-714-8516
Practice Address - Street 1:675 TOWER AVE
Practice Address - Street 2:303
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1273
Practice Address - Country:US
Practice Address - Phone:860-714-3340
Practice Address - Fax:860-714-8516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY RENEWAL TEAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management