Provider Demographics
NPI:1366613614
Name:DKH DIABETES SELF MANAGMENT EDUCATION
Entity type:Organization
Organization Name:DKH DIABETES SELF MANAGMENT EDUCATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-928-6541
Mailing Address - Street 1:346 POMFRET ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1871
Mailing Address - Country:US
Mailing Address - Phone:860-928-4344
Mailing Address - Fax:860-928-4188
Practice Address - Street 1:346 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1871
Practice Address - Country:US
Practice Address - Phone:860-928-4344
Practice Address - Fax:860-928-4188
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAY KIMBALL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-14
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0043261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center