1295827475 NPI number — NEW DIRECTIONS INC. OF NORTH CENTRAL CONN.

Table of content: (NPI 1295827475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295827475 NPI number — NEW DIRECTIONS INC. OF NORTH CENTRAL CONN.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW DIRECTIONS INC. OF NORTH CENTRAL CONN.
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:
1295827475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 ELM ST STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06082-3739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-741-3001
Provider Business Mailing Address Fax Number:
860-741-8332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 ELM ST STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06082-3739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-741-3001
Provider Business Practice Location Address Fax Number:
860-741-8332
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRANCIFORTE
Authorized Official First Name:
SUZANNE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ACCOUNTS RECIEVABLES MANAGER
Authorized Official Telephone Number:
860-741-3001

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  0314, 0270, 0000-003 , 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: A324839 . This is a "VALUE OPTIONS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4553929 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 201366 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CTGA000477 . This is a "STATE ADMIN. GENERAL ASST" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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