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General NPI Number Information
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NPI Number | 1578050605
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Entity Type | Organization
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Legal Business Name | NEW ROADS WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 04/14/2018
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Last Update Date | 04/14/2018
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Provider Practice Location Address
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Address Line | 2911 DIXWELL AVE # B10
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City | HAMDEN
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State | CT
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Zip | 06518-3195
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Country | US
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Telephone | 203-821-7390
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Fax |
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Provider Business Mailing Address
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Address Line | 29 COUNTRY HILLS RD
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City | HAMDEN
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State | CT
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Zip | 06514-3217
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Country | US
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Telephone | 718-669-4113
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | CHARMAINE WALLEN
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Credential |
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Telephone | 718-669-4113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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