Healthcare Provider Details

I. General information

NPI: 1780190272
Provider Name (Legal Business Name): ELEGANT CLINICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 NORTH RD
EAST WINDSOR CT
06088-9678
US

IV. Provider business mailing address

170 NORTH RD
EAST WINDSOR CT
06088-9678
US

V. Phone/Fax

Practice location:
  • Phone: 860-413-9509
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: KAREN KORA GASTON
Title or Position: CEO
Credential: ED.D.
Phone: 860-758-4098