Healthcare Provider Details

I. General information

NPI: 1780919951
Provider Name (Legal Business Name): NEW ERA REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 EAST STREET
NEW HAVEN CT
06511-5838
US

IV. Provider business mailing address

311 EAST STREET
NEW HAVEN CT
06511-5838
US

V. Phone/Fax

Practice location:
  • Phone: 203-562-2101
  • Fax: 203-562-2102
Mailing address:
  • Phone: 203-562-2101
  • Fax: 203-562-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number0381
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number0381
License Number StateCT

VIII. Authorized Official

Name: MR. EBENEZER A KOLADE
Title or Position: EXECUTIVE DIRECTOR
Credential: MD
Phone: 203-562-2101