Healthcare Provider Details

I. General information

NPI: 1508999889
Provider Name (Legal Business Name): REM CONNECTICUT COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MIDDLEFIELD STREET
MIDDLETOWN CT
06457
US

IV. Provider business mailing address

440 MIDDLEFIELD STREET
MIDDLETOWN CT
06457
US

V. Phone/Fax

Practice location:
  • Phone: 860-704-0360
  • Fax: 860-704-8056
Mailing address:
  • Phone: 860-704-0360
  • Fax: 860-704-8056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberR-1013
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: BRETT IAN COHEN
Title or Position: COO
Credential:
Phone: 800-388-5150