Charter Oak Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Hartford, CT
NPI 1992750855 · NPPES record last updated May 8, 2026
Key facts
- NPI
- 1992750855
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 0259 (CT)
- Legal business name
- CHARTER OAK HEALTH CENTER, INC.
- Practice address
- 21 Grand St
Hartford, CT 06106-1541 - Phone
- (860) 550-7500
- NPI assigned
- May 22, 2006
- Organization subpart
- No
Authorized official
- Name
- Tim Powers
- Title
- Chief Compliance Officer
- Phone
- (860) 550-7500
Owners & managing parties with NPI records 1
-
Sunil D'Cunha, MD
Other NPIs with the same Medicare PAC ID 2
Practitioners 124
-
Marisol Acevedo-Cruz, LMFT
-
Muguette C Arenas, APRN
-
Geneva Nicole Beresford, APRN
-
Philip Jacob Bergen Jr., PA-C
-
Karlos Boghosian, D.C
-
Cynthia Neuberger Breen, NP-C
-
Bethune Brown, DC
-
Raymond Castro, M.D.
-
Christina M Cipriani, LCSW, LADC
-
Dariana Cuadrado, DC
-
Mark John Daddio, D.P.M.
-
Carolina Victoria Delaire, PMHNP-BC
-
Dante Goodwin, AGNP
-
Gulchehra Gravel, APRN
-
Theddeus Iheanacho, M.D.
-
Michael David Kelleman, O.D.
-
Meghan Kelly, PA
-
Japheth Ogamba Mongare, D.P.M
-
Mabedia Moreno, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in CT
Federally qualified health center certification: CCN 071819
- Legal name
- CHARTER OAK HEALTH CENTER, INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 31, 1996
- Last certification
- Jul 31, 1996
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 22, 2002 in CT
- Enrollment address
- 21 Grand St
Hartford, CT 61061541
Federally qualified health center certification: CCN 071948
- Legal name
- CHARTER OAK HEALTH CENTER, INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 14, 2020
- Last certification
- Aug 14, 2020
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 20, 2002 in CT
- Enrollment address
- 32 Grand St
Hartford, CT 61064658
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Tim Powers |
Corporate Officer |
Jan 1, 2019 | |
| Corporate Officer |
Oct 1, 2015 | ||
| Rashad C Collins |
Corporate Officer |
Aug 1, 2017 | |
| Sunil B Dcunha |
Corporate Officer |
Apr 1, 2018 | |
| Martin John |
Corporate Director |
Jul 25, 2012 | |
| Ann Marie Patterson |
Corporate Officer | Dec 13, 2005 | |
| Silvia Goldman |
Corporate Officer |
Sep 1, 2018 | |
| Adrian R Wood |
Corporate Director |
May 22, 2013 | |
| Joel Cruz |
Corporate Director |
Apr 24, 2013 | |
| Nichelle a Mullins |
Corporate Officer |
Jan 25, 2012 | |
| Operational/Managerial Control |
Oct 1, 2015 | 100% | |
| Veronica Barcelona |
Corporate Director |
Aug 23, 2023 | |
| Joy-Lynn Hardy |
Corporate Director |
Oct 25, 2023 | |
| Kimberly Evans |
Corporate Officer |
Aug 29, 2022 | |
| Vernette Townsend |
Corporate Officer |
Jan 1, 2025 | 100% |
| Operational/Managerial Control |
Jan 1, 2025 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20021210000011 | CT | Part a Provider - Federally Qualified Health Center (FQHC) | 3870401078 | Practice locations: Hartford, CT |
| O20040220000909 | CT | Part B Supplier - Clinic/Group Practice | 3870401078 |
Receives reassigned benefits from 122 practitioners Practice locations: Hartford, CT; Bloomfield, CT |
| O20200814000463 | CT | Part a Provider - Federally Qualified Health Center (FQHC) | 3870401078 | Practice locations: Hartford, CT |
National Provider Directory
Locations
32 Grand St
Hartford, CT 06106
21 Grand St
Ste 100
Hartford, CT 06106
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | 0259 | CT | Yes |
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | 0312 | CT |
Addresses
Primary practice location
21 Grand St
Hartford, CT 06106-1541
Mailing address
21 Grand St
Hartford, CT 06106-1541
Phone (860) 550-7500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004236007 | Medicaid | CT |
Other providers in Hartford, CT
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- Stanley Edward Chartoff
- Patricia Kelly Chase
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- Nicholas Wayne Chasse
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All providers in Hartford, CT · Federally Qualified Health Center (FQHC) in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.