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General NPI Number Information
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NPI Number | 1174899520
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Entity Type | Organization
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Legal Business Name | RUSHFORD
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 1250 SILVER ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3946
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Country | US
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Telephone | 860-346-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 SILVER ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3946
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICIAN III
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Name | MR. MICHAEL STEADY
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Credential | MS, CRC, LADC
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Telephone | 860-346-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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