Healthcare Provider Details

I. General information

NPI: 1821830514
Provider Name (Legal Business Name): WHEELERCLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 WOODLAND ST
HARTFORD CT
06105-2363
US

IV. Provider business mailing address

43 WOODLAND ST
HARTFORD CT
06105-2363
US

V. Phone/Fax

Practice location:
  • Phone: 860-471-0829
  • Fax:
Mailing address:
  • Phone: 860-471-0829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FELICIANO LABOY
Title or Position: SUPERVISOR
Credential: GS
Phone: 860-471-0829