Charter Oak Health Center, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

00000259 Issued in CT

Legal business name

CHARTER OAK HEALTH CENTER, INC.

Practice address

574 Park St
Hartford, CT 06106-4617

Phone

(860) 550-7500

NPI assigned

Jun 25, 2008

Last updated

May 8, 2026By the provider in NPPES

Organization subpart

Yes

Parent organization

CHARTER OAK HEALTH CENTER INC.As reported in NPPES

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

Authorized official

Name

Tim Powers

Title

Chief Compliance Officer

Phone

(860) 550-7500

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Immaculate Conception Shelter Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073774709. Details of each certification follow.

• CCN 071853 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 071853

Legal name

IMMACULATE CONCEPTION SHELTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jun 19, 2009

Last certification

Jun 19, 2009

Ownership / control type

For profit – corporation

Facility address

574 Park St
Hartford, CT 06106

Part of

Charter Oak Health Center

Locations

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

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778198400000",
    "number": "1073774709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 GRAND ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061061541",
            "telephone_number": "860-550-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "574 PARK ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061064617",
            "telephone_number": "860-550-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARTER OAK HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHARTER OAK HEALTH CENTER INC.",
        "enumeration_date": "2008-06-25",
        "last_updated": "2026-05-08",
        "certification_date": "2026-05-08",
        "status": "A",
        "authorized_official_last_name": "POWERS",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "860-550-7500"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CT",
            "license": "00000259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236007",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Immaculate Conception Shelter",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Charter Oak Health Center, Inc.

• Federally Qualified Health Center (FQHC) in Hartford, CT
• Providers in Hartford, CT by specialty
• Federally Qualified Health Center (FQHC) in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.