St. Vincent Depaul Mission of Waterbury, Inc.

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

RCL-0029 Issued in CT

Legal business name

ST. VINCENT DEPAUL MISSION OF WATERBURY, INC.

Practice address

86 Midland Rd # 88
Waterbury, CT 06705-3414

Phone

(203) 753-3342

Fax

(203) 753-9900

NPI assigned

Mar 1, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Paul Iadarola

Title

Executive Director

Phone

(203) 754-0000

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470873600000",
    "number": "1043348204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "173 MARK LN",
            "address_2": "SUITE 6",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067042474",
            "telephone_number": "203-757-0567",
            "fax_number": "203-757-0568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 MIDLAND RD # 88",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067053414",
            "telephone_number": "203-753-3342",
            "fax_number": "203-753-9900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. VINCENT DEPAUL MISSION OF WATERBURY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2016-08-11",
        "status": "A",
        "authorized_official_last_name": "IADAROLA",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "203-754-0000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "CT",
            "license": "RCL-0029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004246519",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.