Provider Demographics
NPI:1174868442
Name:CT- FAMILY CARE SERVICES, LLC
Entity type:Organization
Organization Name:CT- FAMILY CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTINIAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:RWEYEMAMU
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MDIV, MS-MFT,
Authorized Official - Phone:860-508-8651
Mailing Address - Street 1:155 MAPLE ST
Mailing Address - Street 2:UNIT 207-208
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-2649
Mailing Address - Country:US
Mailing Address - Phone:413-285-8722
Mailing Address - Fax:413-285-8642
Practice Address - Street 1:155 MAPLE ST
Practice Address - Street 2:UNIT 207-208
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-2649
Practice Address - Country:US
Practice Address - Phone:413-285-8722
Practice Address - Fax:413-285-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch