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General NPI Number Information
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NPI Number | 1205083177
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF CONNECTICUT HEATLH CENTER
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Dates
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Enumeration Date | 08/22/2008
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 263 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06032-1956
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Country | US
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Telephone | 860-679-2504
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Fax |
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Provider Business Mailing Address
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Address Line | 263 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06032-1956
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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 | CLINICAL NUTRITION MANAGER
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Name | MS. ANITA V GRINEVICS
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Credential | MS, RD, CSG, CD-N
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Telephone | 860-679-2504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 000639
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License Number State | CT
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