1073679445 NPI number — APT FOUNDATION, INC

Table of content: (NPI 1073679445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073679445 NPI number — APT FOUNDATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APT FOUNDATION, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ORCHARD HILL TREATMENT SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073679445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 LONG WHARF DR
Provider Second Line Business Mailing Address:
SUITE 321
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06511-5991
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-781-4600
Provider Business Mailing Address Fax Number:
203-781-4624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
352 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06473-3108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-781-4600
Provider Business Practice Location Address Fax Number:
203-781-4624
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MADDEN
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
203-781-4600

Provider Taxonomy Codes

  • Taxonomy code: 261QM2800X , with the licence number:  SA-0101 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X , with the licence number: SA-0101 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008058217 . This is a "SEARS MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008064634 . This is a "GARERI MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001218107 . This is a "SCHOTTENFELD MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008050283 . This is a "HAYNES MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008066315 . This is a "COLON RIVERA MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008038019 . This is a "MEDICAID ONOFRIO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008038047 . This is a "DIMEOLA MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001423136 . This is a "TETRAULT MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004082286 . This is a "ORC/MEDICAID/MMT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008038019 . This is a "MEDICAID ONOFRIO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008053091 . This is a "BUTNER MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001302497 . This is a "SHI MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004235083 . This is a "YOUNG MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008037391 . This is a "SHACKELL MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008053715 . This is a "NUNLEY MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008066551 . This is a "DEOLIVEIRA MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 500000315 . This is a "ORC/MEDICAID/SA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008003745 . This is a "DESROSIERS MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008038049 . This is a "PETHO MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008043611 . This is a "ROSS MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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