NPIMap

Organization Active NPI

The Kennedy Collective, Inc.

  • Developmentally Disabled Services Day Training Agency
  • Trumbull, CT
National Provider Identifier
1710004098
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
Legal business name
THE KENNEDY COLLECTIVE, INC.
Practice address
2440 Reservoir Ave
Trumbull, CT 06611-4735
Phone
(203) 365-8522
Fax
(203) 365-8533
NPI assigned
Mar 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

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

Authorized official

Name
Richard Sebastian
Title
President and Ceo
Phone
(203) 365-8522

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X CT Primary

Addresses

Primary practice location

2440 Reservoir Ave
Trumbull, CT 06611-4735

Mailing address

2440 Reservoir Ave
Trumbull, CT 06611-4735
Phone (203) 332-4535

Other identifiers 1

IdentifierTypeStateIssuer
004186054MedicaidCT

National Provider Directory

National Provider Directory
Tax ID family
The Kennedy Center Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

39 Lindeman Dr
Trumbull, CT 06611
Phone (203) 332-4535

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713830400000",
    "number": "1710004098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2440 RESERVOIR AVE",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066114735",
            "telephone_number": "203-332-4535",
            "fax_number": "203-332-4539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2440 RESERVOIR AVE",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066114735",
            "telephone_number": "203-365-8522",
            "fax_number": "203-365-8533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE KENNEDY COLLECTIVE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A",
        "authorized_official_last_name": "SEBASTIAN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "203-365-8522"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "CT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004186054",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Trumbull, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; 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.