Healthcare Provider Details

I. General information

NPI: 1700384856
Provider Name (Legal Business Name): TRICIRCLE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WAY RD
MIDDLEFIELD CT
06455-1080
US

IV. Provider business mailing address

6 WAY RD
MIDDLEFIELD CT
06455-1080
US

V. Phone/Fax

Practice location:
  • Phone: 860-349-7074
  • Fax: 860-349-7032
Mailing address:
  • Phone: 860-349-7074
  • Fax: 860-349-7032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ANA M GOPOIAN
Title or Position: FOUNDER, EXECUTIVE DIRECTOR
Credential: BA, CPRC, RSS, CHT.
Phone: 203-349-7074