| Immaculate Conception Shelter | |
|
574 Park St Hartford CT 06106-4617 | |
| (860) 550-7500 | |
| Not Available |
| Full Name | Immaculate Conception Shelter |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 574 Park St, Hartford, Connecticut |
| Authorized Official Name and Position | Tim Powers (CHIEF COMPLIANCE OFFICER) |
| Authorized Official Contact | 8605507500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Immaculate Conception Shelter 21 Grand St Hartford CT 06106-1541 Ph: (860) 550-7500 | Immaculate Conception Shelter 574 Park St Hartford CT 06106-4617 Ph: (860) 550-7500 |
| NPI Number | 1073774709 |
|---|---|
| Provider Enumeration Date | 06/25/2008 |
| Last Update Date | 05/08/2026 |
| Certification Date | 05/08/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073774709 | NPI | - | NPPES |
| 004236007 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 00000259 (Connecticut) | Primary |
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