MEDICARE: HEARING WELLNESS CENTER OF CONNECTICUT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	000352	CT

General Provider Information

NPI Number	:	1386769453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARING WELLNESS CENTER OF CONNECTICUT, LLC

Provider Business Mailing Address
First Line	:	240 N MAIN ST
Second Line	:
City	:	MANCHESTER
State	:	CT
Zip	:	06042-2004
Country	:	US
Telephone Number	:	860-643-4413
Fax Number	:	860-643-4436

Provider Business Practice Location Address
First Line	:	240 N MAIN ST
Second Line	:
City	:	MANCHESTER
State	:	CT
Zip	:	06042-2004
Country	:	US
Telephone Number	:	860-643-4413
Fax Number	:	860-643-4436

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RICHARD J MANCINI
Credential	:	BC-HIS
Telephone Number	:	860-643-4413

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	08/22/2020

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