Time for a Change Ministry

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

17053333309021 Issued in CT

Legal business name

TIME FOR A CHANGE MINISTRY

Practice address

880 Hancock Ave
Bridgeport, CT 06605-1930

Phone

(203) 818-5091

Fax

(203) 923-8472

NPI assigned

Jun 23, 2014

Last updated

Jun 23, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Lou Holiday

Title

Supervisor

Phone

(203) 818-5091

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403481600000",
    "number": "1801201330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 HANCOCK AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066051930",
            "telephone_number": "203-818-5091",
            "fax_number": "203-923-8472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 HANCOCK AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066051930",
            "telephone_number": "203-818-5091",
            "fax_number": "203-923-8472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIME FOR A CHANGE MINISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-23",
        "last_updated": "2014-06-23",
        "status": "A",
        "authorized_official_last_name": "HOLIDAY",
        "authorized_official_first_name": "LOU",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "203-818-5091",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CT",
            "license": "17053333309021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Francis Thung, MD
• Francis Vincent Tiberi, DMD
• Thomas J Tiberi, DMD
• Evan Tilley, MD
• Amond Tillman
• Dorothy A Timmermann, LMFT
• Nicole Marie Timpanelli, APRN, FNP-BC
• Peter J Tinnesz, CRNA
• Sheldon Marie Tinsay, PT
• Annette Tirado, LCSW

• Substance Abuse Rehabilitation Facility in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Substance Abuse Rehabilitation Facility in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; 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.