1265649297 NPI number — RECOVERY NETWORK OF PROGRAMS, INC.

Table of content: (NPI 1265649297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265649297 NPI number — RECOVERY NETWORK OF PROGRAMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECOVERY NETWORK OF PROGRAMS, 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:
Provider Other Organization Name Type Code:
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:
1265649297
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 TRAP FALLS RD
Provider Second Line Business Mailing Address:
SUITE 405
Provider Business Mailing Address City Name:
SHELTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06484-4616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-929-1954
Provider Business Mailing Address Fax Number:
203-929-1279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
964 IRANISTAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06604-3710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-367-0025
Provider Business Practice Location Address Fax Number:
203-337-6239
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAMILTON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
203-929-1954

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  ORLC0026 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004246733 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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