Organization
GILEAD COMMUNITY SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL E OSBORNE LCSW (EXECUTIVE DIRECTOR)
(860) 343-5300
Entity
Organization
Contact information
Practice address
230 MAIN STREET EXT, MIDDLETOWN, CT 06457-4470
(860) 343-5300
(830) 343-5306
Mailing address
222 MAIN STREET EXT, P.O. BOX 1000, MIDDLETOWN, CT 06457-4406
(860) 343-5300
(860) 343-5306
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
0543
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004140505
—
CT
01
—
C01863
PTAN
CT
Enumeration date
11/10/2005
Last updated
06/27/2019
Update your record
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