| NPI | 1255372108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBENEZER ADEKUNLE KOLADE Executive Director 203-562-2101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: CT 0266) |
| Additional Taxonomies | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Licence: CT 0266) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CT 042947) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: CT 042947) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: CT 040029) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: CT 0266) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2021-05-12 |