| NPI | 1225042542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH ELIZABETH LOCKERY Administrator 203-248-2116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: CT CCF/RT-2) |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: CT EDT-1) |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: CT OPCC-51) | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: CT SA-0093) | |
| 323P00000X Psychiatric Residential Treatment Facility (Licence: CT CCF/RT-73) | |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2014-10-23 |