Healthcare Provider Details

I. General information

NPI: 1457592560
Provider Name (Legal Business Name): NEW HOPE MANOR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 MAIN ST SUITE 303
MANCHESTER CT
06040-6059
US

IV. Provider business mailing address

20 HARTFORD RD
MANCHESTER CT
06040-5973
US

V. Phone/Fax

Practice location:
  • Phone: 860-643-2701
  • Fax: 860-647-8383
Mailing address:
  • Phone: 860-643-2701
  • Fax: 860-647-8383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYL FASANO
Title or Position: CEO/PRESIDENT
Credential: MBA
Phone: 860-643-2701