PARK CITY PRIMARY CARE CENTER (Credential# 929152) is licensed (Psychiatric Outpatient Clinic) with Connecticut Department of Consumer Protection. The license effective date is April 1, 2017. The license expiration date date is March 31, 2021. The license status is ACTIVE.
PARK CITY PRIMARY CARE CENTER is licensed with the Department of Consumer Protection of Connecticut. The credential number is #POCA.0000462. The credential type is psychiatric outpatient clinic. The effective date is April 1, 2017. The expiration date is March 31, 2021. The business address is 64 Black Rock Ave, Bridgeport, CT 06605-1200. The current status is active.
| Licensee Name | PARK CITY PRIMARY CARE CENTER |
| Business Name | PARK CITY PRIMARY CARE CENTER |
| Doing Business As | PARK CITY PRIMARY CARE CENTER |
| Credential ID | 929152 |
| Credential Number | POCA.0000462 |
| Credential Type | Psychiatric Outpatient Clinic |
| Business Address |
64 Black Rock Ave Bridgeport CT 06605-1200 |
| Business Type | BUSINESS |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2009-06-19 |
| Effective Date | 2017-04-01 |
| Expiration Date | 2021-03-31 |
| Refresh Date | 2019-07-22 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1231442 | SA.0000475 | Substance Abuse | 2014-06-26 | 2018-04-01 - 2020-03-31 | ACTIVE IN RENEWAL |
| Street Address | 64 BLACK ROCK AVE |
| City | BRIDGEPORT |
| State | CT |
| Zip Code | 06605-1200 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Emely E. Gonzalez | 64 Black Rock Ave, Bridgeport, CT 06605-1200 | Community Health Worker | 2020-03-19 ~ 2023-03-31 |
| Park City Primary Care Center, Inc. | 64 Black Rock Ave, Bridgeport, CT 06605-1200 | Outpatient Clinic | 2017-04-01 ~ 2021-03-31 |
| Theresa Integral Dy Djama | 64 Black Rock Ave, Bridgeport, CT 06605-1649 | Controlled Substance Registration for Practitioner | 2019-07-05 ~ 2021-02-28 |
| Debra L Gerson | 64 Black Rock Ave, Bridgeport, CT 06605-1200 | Physician/surgeon | 2018-03-01 ~ 2019-02-28 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Melissa Medina | 102 Clinton Ave., Bridgeport, CT 06605 | Medication Administration Certification | ~ |
| Maria Etelvina Lema | 20 Orland St, Bridgeport, CT 06605 | Nail Technician | ~ |
| Michelle Maldonado M�ndez | 182 Monroe St, Bridgeport, CT 06605 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Latavia Henderson | 178 Lewis Street, Bridgeport, CT 06605 | Medication Administration Certification | 2020-06-08 ~ 2022-06-07 |
| Onedu Nnenna Benson | 285 Laurel Avenue, Bridgeport, CT 06605 | Licensed Practical Nurse | ~ |
| Gregory A Korth | 137 Fayerweather Ter, Bridgeport, CT 06605 | Architect | 2020-08-01 ~ 2021-07-31 |
| Kim Anh Ho | 108 Wood Avenue, Bridgeport, CT 06605 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Maria-elena Melchor Mora | 653 Colorado Ave, Bridgeport, CT 06605 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Jennifer Nelson | 148 St Stephens Road, Bridgeport, CT 06605 | Esthetician | ~ |
| Santa Fuel Inc | 133 Admiral St, Bridgeport, CT 06605 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06605 | |||
| City | BRIDGEPORT |
| Zip Code | 06605 |
| License Type | Psychiatric Outpatient Clinic |
| License Type + County | Psychiatric Outpatient Clinic + BRIDGEPORT |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Park City Primary Care Center, Inc. | 64 Black Rock Ave, Bridgeport, CT 06605-1200 | Outpatient Clinic | 2017-04-01 ~ 2021-03-31 |
| Park City Primary Care Center Inc. · Park City Primary Care Center, Inc. | 695 Park Avenue, Bridgeport, CT 06604 | Outpatient Clinic | ~ 2001-12-31 |
| Park City Primary Care Center Inc. | 695 Park Avenue, Bridgeport, CT 06604 | Public Charity | ~ |
| Bridges Primary Care Center | 949 Bridgeport Ave, Milford, CT 06460-3142 | Outpatient Clinic | 2019-04-01 ~ 2022-03-31 |
| Apt Foundation, Inc. Primary Care Services | 1 Long Wharf Dr Ste 321, New Haven, CT 06511-5991 | Outpatient Clinic | 2019-01-01 ~ 2021-12-31 |
| Connecticut Center for Primary Care Inc. | 3 Farm Glen Blvd, Farmington, CT 06032-1981 | Public Charity | 2017-12-01 ~ 2018-11-30 |
| Apt Foundation, Inc. Primary Care Services | 425 Grant St, Bridgeport, CT 06610-3222 | Outpatient Clinic | 2015-01-01 ~ 2018-12-31 |
| Apt Foundation, Inc. Primary Care Services | New Haven, CT 06519 | Outpatient Clinic | ~ |
| Health Care for The Homeless Clinic At South Park Inn | 75 Main St, Hartford, CT 06106-1806 | Psychiatric Outpatient Clinic | 2018-01-01 ~ 2021-12-31 |
| Primary Eye Care | 1080 Day Hill Rd, Windsor, CT 06095-1781 | Optical Selling Permit | 2020-09-01 ~ 2021-08-31 |
Please comment or provide details below to improve the information on PARK CITY PRIMARY CARE CENTER.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).