Healthcare Provider Details

I. General information

NPI: 1396050209
Provider Name (Legal Business Name): NORTH STONINGTON HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 PROVIDENCE NEW LONDON TPKE # E8
NORTH STONINGTON CT
06359-1721
US

IV. Provider business mailing address

183 PROVIDENCE NEW LONDON TPKE # E8
NORTH STONINGTON CT
06359-1721
US

V. Phone/Fax

Practice location:
  • Phone: 860-535-2273
  • Fax: 860-535-0204
Mailing address:
  • Phone: 860-535-2273
  • Fax: 860-535-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCL-0676
License Number StateCT

VIII. Authorized Official

Name: MS. JEANNE LACHANCE
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 401-348-3711