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General NPI Number Information
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NPI Number | 1699134742
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Entity Type | Organization
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Legal Business Name | MOUNTAINSIDE TREATMENT CENTER
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 187 S CANAAN RD
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City | CANAAN
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State | CT
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Zip | 06018-2544
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Country | US
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Telephone | 860-362-5051
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Fax |
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Provider Business Mailing Address
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Address Line | 187 S CANAAN RD
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City | CANAAN
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State | CT
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Zip | 06018-2544
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Country | US
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Telephone | 860-362-5051
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Fax |
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Authorized Official
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Title or Position | CLINICAL INTEGRATION MANAGER
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Name | BRITTANIE DECKER
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Credential |
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Telephone | 860-362-5051
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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 | 1181
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License Number State | CT
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