Organization
/WAYFARING MINISTRIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER JOHNSON (ADMINISTRATOR)
(203) 533-9512
Entity
Organization
Contact information
Practice address
29R MARNE ST REAR, HAMDEN, CT 06514-3628
(203) 533-9512
(203) 248-4572
Mailing address
29R MARNE ST REAR, HAMDEN, CT 06514-3628
(203) 533-9512
(203) 248-4572
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
003563
CT
305S00000X
Point of Service
Primary
003563
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003563
—
CT
Enumeration date
10/17/2014
Last updated
10/17/2014
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