MEDICARE: THE CONNECTION INC.

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	320800000X	Mental Illness Community Based Residential Treatment Facility	RLC-0012	CT
2	261QM0850X	Adult Mental Health Clinic/Center	0048	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	207000827	OTHER	CT	EDS TRADING PROVIDER #
2	004247880	OTHER	CT	EDS PROVIDER NUMBER

General Provider Information

NPI Number	:	1992823538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CONNECTION INC.

Provider Business Mailing Address
First Line	:	205 ORANGE STREET
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06510
Country	:	US
Telephone Number	:	203-776-9900
Fax Number	:

Provider Business Practice Location Address
First Line	:	282 DWIGHT ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-3233
Country	:	US
Telephone Number	:	203-777-3216
Fax Number	:	203-772-0705

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. LINDSEY M BOHAN
Credential	:
Telephone Number	:	203-776-9900

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	01/11/2013

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