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General NPI Number Information
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NPI Number | 1215620968
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Entity Type | Organization
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Legal Business Name | MULLIGAN RECOVERY CENTERS OF CONNECTICUT, LLC
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 351 WINTHROP AVE
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City | NEW HAVEN
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State | CT
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Zip | 06511-4130
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Country | US
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Telephone | 305-902-0177
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Fax |
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Provider Business Mailing Address
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Address Line | 50 SILLIMAN RD
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City | WALLINGFORD
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State | CT
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Zip | 06492-2036
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Country | US
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Telephone | 305-902-0177
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. RACHAEL DOLS
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Credential |
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Telephone | 305-902-0177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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