HEALING WATERS/LIFE CHANGERS LLC (NPI# 1033750526) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033750526 |
| Entity Type | Organization |
| Organization Name | HEALING WATERS/LIFE CHANGERS LLC |
| Practice Address |
1229 Albany Ave Ste 4 Hartford CT 06112-2156 |
| Practice Telephone | 8602462323 |
| Mailing Telephone | 8602462323 |
| Enumeration Date | 2019-10-05 |
| Last Update Date | 2019-10-05 |
| Authorized Official Name | MRS. JACQUELINE PHILLIPS (OWNER) |
| Authorized Official Telephone | 8607297239 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities | ||
| N | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
Residential Treatment Facilities | ||
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Street Address |
1229 ALBANY AVE STE 4 |
| City | HARTFORD |
| State | CT |
| Zip Code | 06112-2156 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487936498 | Karen L Bailey Addison | Social Worker | 1229 Albany Ave Ste 4, Hartford, CT 06112-2156 | 2011-09-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841810355 | Ashwin Mahesh | Student in an Organized Health Care Education/Training Program | 131 Coventry Street, 2nd Floor, Burgdorf Clinic, Hartford, CT 06112 | 2020-04-24 |
| 1336600527 | Waleed Ibrahim | Student in an Organized Health Care Education/Training Program | Burgdorf Clinic, 131 Coventry Street 2nd Floor, Hartford, CT 06112 | 2019-03-29 |
| 1740741941 | Hajra Munawar | Student in an Organized Health Care Education/Training Program | Burgdorf Clinic 131 Coventry Street, Hartford, CT 06112 | 2019-03-29 |
| 1194191973 | Esther Wint | Nurse Practitioner | 490 Blue Ave, Hartford, CT 06112 | 2015-08-17 |
| 1194105700 | Michelle Russi | Physical Therapy Assistant | 490 Blue Hill Ave., Hartford, CT 06112 | 2015-06-09 |
| 1366858359 | Krysten N Marotta | Pharmacist | 1290 Albany Ave, Hartford, CT 06112 | 2014-07-10 |
| 1447403522 | Moon Hee Yoo | Psychiatry & Neurology | 500 Vine St., Capitol Region Mental Health Center, Hartford, CT 06112 | 2008-11-03 |
| 1992958094 | Roxann Marie Ellis-denby | Social Worker | 51 Coventry Street, Capitol Region Mental Health Center, Hartford, CT 06112 | 2008-11-03 |
| 1265590871 | The Connecticut Institute for The Blind | Intermediate Care Facility, Mentally Retarded | 120 Holcomb Street, Hartford, CT 06112 | 2006-12-05 |
| 1164580379 | Intercommunity, Inc. | Clinic/Center | 16 Coventry Street, Hartford, CT 06112 | 2006-12-04 |
| Find all providers in zip 06112 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750992244 | Connecting The Pieces, LLC | Clinic/Center | 151 New Park Ave Unit 27, Hartford, CT 06106-2181 | 2020-08-10 |
| 1558859587 | The Matthew Project, Inc. | Clinic/Center | 843 Bridlewood Dr, Hartford, WI 53027-2799 | 2018-04-25 |
| 1245324516 | Catholic Charities Inc - Archdiocese of Hartford | Clinic/Center | 45 Wadsworth St., Hartford, CT 06106 | 2006-10-03 |
| 1467545251 | Catholic Charities, Inc. - Archdiocese of Hartford | Clinic/Center | 896 Asylum Ave, Hartford, CT 06105-1901 | 2006-10-02 |
| 1841301876 | Community Renewal Team, Inc. | Clinic/Center | 330 Market Street, Hartford, CT 06120 | 2006-08-31 |
| 1972592186 | Hartford Community Mental Health Center Inc. | Clinic/Center | 2550 Main St, Hartford, CT 06120-1936 | 2005-10-19 |
| 1437769122 | Klingberg Family Centers Inc | Clinic/Center | 157 Charter Oak Ave, Hartford, CT 06106-1913 | 2020-08-06 |
| 1104949973 | Hartford Dispensary | Clinic/Center | 345 Main St, Hartford, CT 06106-1824 | 2007-04-09 |
| 1912020793 | Hartford Dispesary | Clinic/Center | 345 Main St, Hartford, CT 06106-1824 | 2007-04-09 |
| 1992750855 | Charter Oak Health Center, Inc. | Clinic/Center | 21 Grand St, Hartford, CT 06106-1541 | 2006-05-22 |
| Find all providers in HARTFORD | ||||
Please comment or provide details below to improve the information on HEALING WATERS/LIFE CHANGERS LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.