CHARTER OAK HEALTH CENTER, INC. (NPI# 1831351568) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831351568 |
| Entity Type | Organization |
| Organization Name | CHARTER OAK HEALTH CENTER, INC. |
| Other Organization Name | BACON CONGREGATE |
| Practice Address |
21 Grand St Hartford CT 06106-1541 |
| Mailing Address |
43 Morris St Hartford CT 06114-6002 |
| Practice Telephone | 8605507500 |
| Mailing Telephone | 8605507562 |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2008-12-05 |
| Authorized Official Name | ALFREDA TURNER (PRESIDENT AND CEO) |
| Authorized Official Telephone | 8605507500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
00000259 | CT | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 004236007 | 05 |
| Other Name | Type Code |
|---|---|
| Bacon Congregate | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447719091 | Charter Oak Health Center, Inc. | Clinic/Center | 693 Bloomfield Ave Ste 101, Bloomfield, CT 06002-2489 | 2019-03-13 |
| 1073774709 | Charter Oak Health Center, Inc. | Clinic/Center | 574 Park St, Hartford, CT 06106-4617 | 2008-06-25 |
| 1851552582 | Charter Oak Health Center, Inc. | Clinic/Center | 437 Sheldon St, Hartford, CT 06106-1939 | 2008-06-25 |
| 1912169640 | Charter Oak Health Center, Inc. | Clinic/Center | 34 Huyshope Ave, Hartford, CT 06106-2815 | 2008-06-25 |
| 1093274771 | Charter Oak Health Center, Inc. | Clinic/Center | 1755 Park St, Hartford, CT 06106-2160 | 2019-03-13 |
| 1396906020 | Charter Oak Health Center, Inc. | Clinic/Center | 21 Grand St, Hartford, CT 06106-1541 | 2008-06-25 |
| 1902068638 | Charter Oak Health Center, Inc. | Clinic/Center | 401 New Britain Ave, Hartford, CT 06106-3833 | 2008-06-25 |
| 1669633392 | Charter Oak Health Center, Inc. | Clinic/Center | 118 Main St, Hartford, CT 06106-1817 | 2008-06-25 |
| 1003078734 | Charter Oak Health Center, Inc. | Clinic/Center | 21 Grand St, Hartford, CT 06106-1541 | 2008-06-25 |
| 1639331366 | Charter Oak Health Center, Inc. | Clinic/Center | 21 Grand St, Hartford, CT 06106-1541 | 2008-06-25 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | CHARTER OAK HEALTH CENTER, INC. | 21 Grand Street, Hartford, CT 06106 |
| Street Address |
21 GRAND ST |
| City | HARTFORD |
| State | CT |
| Zip Code | 06106-1541 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558364653 | Jennifer A Colucci | Nurse Practitioner | 21 Grand St, Hartford, CT 06106-1541 | 2005-05-23 |
| 1518583780 | Ludwig V Rosiclair | Pharmacist | 21 Grand St, Hartford, CT 06106-1541 | 2020-06-23 |
| 1235752866 | Philip Jacob Bergen Jr. | Physician Assistant | 21 Grand St, Hartford, CT 06106-1541 | 2020-05-18 |
| 1982243580 | Melissa Richardson | Nurse Practitioner | 21 Grand St, Hartford, CT 06106-1541 | 2019-12-30 |
| 1841838596 | Kristal Velazquez | Midwife | 21 Grand St, Hartford, CT 06106-1541 | 2019-12-12 |
| 1346888237 | Jillian Smith | Advanced Practice Midwife | 21 Grand St, Hartford, CT 06106-1541 | 2019-12-11 |
| 1467002634 | Stephanie Marie Watson | Physician Assistant | 21 Grand St, Hartford, CT 06106-1541 | 2019-09-18 |
| 1598311763 | Joeli Mcquaid-robert | Social Worker | 21 Grand St, Hartford, CT 06106-1541 | 2019-08-14 |
| 1487207718 | Andrea Fachini | Physician Assistant | 21 Grand St, Hartford, CT 06106-1541 | 2019-07-16 |
| 1831758366 | Kelly Ruiz | Physician Assistant | 21 Grand St, Hartford, CT 06106-1541 | 2019-06-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750907325 | Vartika Kesarwani | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care-brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2020-06-19 |
| 1720602865 | Meher Kaur Singha | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care- Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2020-06-04 |
| 1497314140 | Eduardo Mantovani Cardoso | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adut Primary Care - Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2019-06-06 |
| 1114582178 | Dimitrios Drekolias | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care - Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2019-05-06 |
| 1316501687 | Rafae Shaikh | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2019-04-23 |
| 1437643715 | Lucas Bensa | Social Worker | 421 Washington St., Apt C1, Hartford, CT 06106 | 2018-06-19 |
| 1548754310 | Collin Dimler | Physician Assistant | 85 Seymour St Ste 1003, Hartford, CT 06106 | 2018-06-15 |
| 1619460581 | Bryan F Stringer | Student in an Organized Health Care Education/Training Program | 79 Retreat Ave., Hh-adult Primary Care - Brown Stone, Hartford, CT 06106 | 2018-06-14 |
| 1083103972 | Margret Sigurdardottir Blondal | Student in an Organized Health Care Education/Training Program | 282 Washington Street, Ste 4h, Hartford, CT 06106 | 2018-05-07 |
| 1265920995 | Rudra Ramanathan | Student in an Organized Health Care Education/Training Program | 79 Retreat Ave Brown Stone, Hartford, CT 06106 | 2018-04-27 |
| Find all providers in zip 06106 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073774709 | Charter Oak Health Center, Inc. | Clinic/Center | 574 Park St, Hartford, CT 06106-4617 | 2008-06-25 |
| 1851552582 | Charter Oak Health Center, Inc. | Clinic/Center | 437 Sheldon St, Hartford, CT 06106-1939 | 2008-06-25 |
| 1912169640 | Charter Oak Health Center, Inc. | Clinic/Center | 34 Huyshope Ave, Hartford, CT 06106-2815 | 2008-06-25 |
| 1093274771 | Charter Oak Health Center, Inc. | Clinic/Center | 1755 Park St, Hartford, CT 06106-2160 | 2019-03-13 |
| 1093163883 | Community Health Center, Inc | Clinic/Center | 76 New Britain Ave, Hartford, CT 06106-3305 | 2016-06-02 |
| 1801049200 | Charter Oak Health Center Inc. | Clinic/Center | 21 Grand St, Hartford, CT 06106-1541 | 2008-10-29 |
| 1396906020 | Charter Oak Health Center, Inc. | Clinic/Center | 21 Grand St, Hartford, CT 06106-1541 | 2008-06-25 |
| 1902068638 | Charter Oak Health Center, Inc. | Clinic/Center | 401 New Britain Ave, Hartford, CT 06106-3833 | 2008-06-25 |
| 1669633392 | Charter Oak Health Center, Inc. | Clinic/Center | 118 Main St, Hartford, CT 06106-1817 | 2008-06-25 |
| 1003078734 | Charter Oak Health Center, Inc. | Clinic/Center | 21 Grand St, Hartford, CT 06106-1541 | 2008-06-25 |
| Find all providers in HARTFORD | ||||
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| 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.