1346315231 NPI number — CONNECTICUT CLINICAL NURSING ASSOCIATES, LLC

Table of content: (NPI 1346315231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346315231 NPI number — CONNECTICUT CLINICAL NURSING ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTICUT CLINICAL NURSING ASSOCIATES, LLC
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:
1346315231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1535
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06011-1535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-340-8280
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 KEEGAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06782-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-340-8280
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MILNE
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
860-340-8280

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  000638 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 002938 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 003747 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364S00000X , with the licence number: 001126 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364S00000X , with the licence number: 002671 , 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)