Healthcare Provider Details

I. General information

NPI: 1598204893
Provider Name (Legal Business Name): APT FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 E RAMSDELL ST
NEW HAVEN CT
06515-1140
US

IV. Provider business mailing address

1 LONG WHARF DR SUITE 321
NEW HAVEN CT
06511-5991
US

V. Phone/Fax

Practice location:
  • Phone: 203-781-4600
  • Fax: 203-781-4624
Mailing address:
  • Phone: 203-781-4600
  • Fax: 203-781-4624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number529
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number529
License Number StateCT

VIII. Authorized Official

Name: MS. LYNN M MADDEN
Title or Position: PRESIDENT, CEO
Credential: MPA
Phone: 203-781-4600