NPIMap

Organization Active NPI

/Wayfaring Ministries

  • Point of Service
  • Hamden, CT
National Provider Identifier
1891199931
Registry record updated Oct 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Point of ServiceTaxonomy code 305S00000X
License
003563 Issued in CT
Legal business name
/WAYFARING MINISTRIES
Practice address
29R Marne St Rear
Hamden, CT 06514-3628
Phone
(203) 533-9512
Fax
(203) 248-4572
NPI assigned
Oct 17, 2014
Last updated
Oct 17, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2014

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

Authorized official

Name
Roger Johnson
Title
Administrator
Phone
(203) 533-9512

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 003563 CT
Point of Service 305S00000X 003563 CT Primary

Addresses

Primary practice location

29R Marne St Rear
Hamden, CT 06514-3628

Mailing address

29R Marne St Rear
Hamden, CT 06514-3628
Phone (203) 533-9512

Other identifiers 1

IdentifierTypeStateIssuer
003563MedicaidCT

National Provider Directory

National Provider Directory
Tax ID family
Futures2 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

29R Marne St
Rear
Hamden, CT 06514
Phone (203) 533-9512

NPI Registry JSON

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

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413504000000",
    "number": "1891199931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29R MARNE ST REAR",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065143628",
            "telephone_number": "203-533-9512",
            "fax_number": "203-248-4572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29R MARNE ST REAR",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065143628",
            "telephone_number": "203-533-9512",
            "fax_number": "203-248-4572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "/WAYFARING MINISTRIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-17",
        "last_updated": "2014-10-17",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "203-533-9512"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CT",
            "license": "003563",
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "CT",
            "license": "003563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003563",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamden, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.