Healthcare Provider Details

I. General information

NPI: 1447072988
Provider Name (Legal Business Name): SANA2 COLITA ADULT BEHAVIORAL HEALTH RX. TREATMENT & WELLNESS REFUGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 SILAS DEANE HWY STE 2
WETHERSFIELD CT
06109-2123
US

IV. Provider business mailing address

433 SILAS DEANE HWY STE 2
WETHERSFIELD CT
06109-2123
US

V. Phone/Fax

Practice location:
  • Phone: 860-503-0960
  • Fax:
Mailing address:
  • Phone: 860-503-0960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. MARIA RUIZ
Title or Position: MANAGING MEMBER
Credential: APRN
Phone: 860-503-0960