Healthcare Provider Details

I. General information

NPI: 1811435571
Provider Name (Legal Business Name): CONNECTICUT RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 HIGHLAND AVE
CHESHIRE CT
06410-2540
US

IV. Provider business mailing address

288 HIGHLAND AVE
CHESHIRE CT
06410-2540
US

V. Phone/Fax

Practice location:
  • Phone: 203-806-5355
  • Fax: 203-439-9077
Mailing address:
  • Phone: 203-806-5355
  • Fax: 203-439-9077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER BALLEW
Title or Position: PSYCHIATRIST
Credential: D.O.
Phone: 203-467-7563