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General NPI Number Information
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NPI Number | 1134321094
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Entity Type | Organization
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Legal Business Name | WHOLE LIFE INC.
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 59 DUNN HILL RD
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City | TOLLAND
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State | CT
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Zip | 06084-2415
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Country | US
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Telephone | 860-872-4871
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Fax | 860-872-6524
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Provider Business Mailing Address
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Address Line | 216 BROAD STREET 3RD FLOOR
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City | NEW LONDON
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State | CT
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Zip | 06320-5335
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Country | US
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Telephone | 860-886-6900
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Fax | 860-574-9223
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Authorized Official
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Title or Position | CONTROLLER
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Name | MRS. MELISSA ANN SZUBA
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Credential |
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Telephone | 860-886-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | R-1316
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License Number State | CT
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