Healthcare Provider Details

I. General information

NPI: 1982155859
Provider Name (Legal Business Name): APT FOUNDATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 FRONT AVE
WEST HAVEN CT
06516-2836
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 Number0515
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number0515
License Number StateCT

VIII. Authorized Official

Name: MS. LYNN M MADDEN
Title or Position: PRESIDENT/CHIEF EXECUTIVE OFFICER
Credential: MPA
Phone: 203-781-4600