New Canaan Group Home Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

NEW CANAAN GROUP HOME INC

Practice address

162 South Ave
New Canaan, CT 06840-5728

Phone

(203) 846-9581

Fax

(203) 847-0545

NPI assigned

Jul 16, 2020

Last updated

Jul 16, 2020By 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

Katie J Banzhaf

Title

Executive Director

Phone

(203) 846-9581

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• South Avenue Cottage Other name

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1594857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594857600000",
    "number": "1871101733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "162 SOUTH AVE",
            "city": "NEW CANAAN",
            "state": "CT",
            "postal_code": "068405728",
            "telephone_number": "203-846-9581",
            "fax_number": "203-847-0545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 SOUTH AVE",
            "city": "NEW CANAAN",
            "state": "CT",
            "postal_code": "068405728",
            "telephone_number": "203-846-9581",
            "fax_number": "203-847-0545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW CANAAN GROUP HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-16",
        "last_updated": "2020-07-16",
        "certification_date": "2020-07-16",
        "status": "A",
        "authorized_official_last_name": "BANZHAF",
        "authorized_official_first_name": "KATIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "203-846-9581"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DDS LICENSE NUMBER",
            "identifier": "002900",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.starct.org",
            "affiliation": "N",
            "endpointDescription": "website",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "162 South Ave",
            "city": "New Canaan",
            "state": "CT",
            "country_code": "US",
            "postal_code": "068405728",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "South Avenue Cottage",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in New Canaan, CT
• Providers in New Canaan, CT by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; 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.