Healthcare Provider Details

I. General information

NPI: 1174397467
Provider Name (Legal Business Name): CONNECTICUT INFUSION NURSES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 WOODHOUSE AVE
WALLINGFORD CT
06492-5450
US

IV. Provider business mailing address

597 WOODHOUSE AVE
WALLINGFORD CT
06492-5450
US

V. Phone/Fax

Practice location:
  • Phone: 203-415-1542
  • Fax:
Mailing address:
  • Phone: 203-415-1542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. KYLE THOMAS WADE
Title or Position: CEO
Credential:
Phone: 203-415-1542