07D2180467 CLIA NUMBER - BOYS & GIRLS VILLAGE INC 170 BENNETT ST BRIDGEPORT LOCATION

Laboratory Demographics

CLIA Number: 07D2180467

Facility Name: BOYS & GIRLS VILLAGE INC 170 BENNETT ST BRIDGEPORT LOCATION

Facility Address:
170 BENNETT ST
BRIDGEPORT, CT
ZIP 06605
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Facility Phone Number: 203 877-0300

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1477583581

Taxonomy: 261QM0855X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.

CLIA Record

Field Name	Field Value
CLIA Number	07D2180467
LAB Type	Home Health Agency
Facility Name	BOYS & GIRLS VILLAGE INC 170 BENNETT ST BRIDGEPORT LOCATION
Street	170 BENNETT ST
City	BRIDGEPORT
State	CT
ZIP	06605
Phone	203 877-0300
CertificateType	4
CertificateEffectiveDate	3/16/2024
CertificateExpirationDate	3/15/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024