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General NPI Number Information
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NPI Number | 1346812344
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Entity Type | Organization
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Legal Business Name | RESONANT CAPITAL LLC
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Dates
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Enumeration Date | 07/11/2021
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Last Update Date | 07/11/2021
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Provider Practice Location Address
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Address Line | 1 E SHORE AVE
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City | GROTON
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State | CT
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Zip | 06340-8837
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Country | US
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Telephone | 860-333-7654
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Fax |
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Provider Business Mailing Address
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Address Line | 1 E SHORE AVE
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City | GROTON
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State | CT
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Zip | 06340-8837
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Country | US
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Telephone | 860-333-7654
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | BLAKE EDWARDS
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Credential |
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Telephone | 860-333-7654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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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 | 261QG0250X
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Taxonomy Name | Genetics Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR1100X
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Taxonomy Name | Research Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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