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General NPI Number Information
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NPI Number | 1730549759
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Entity Type | Organization
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Legal Business Name | LIVING SPRING LLC
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 57 PLAINS RD
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City | MILFORD
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State | CT
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Zip | 06461-2573
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Country | US
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Telephone | 203-874-0593
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Fax |
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Provider Business Mailing Address
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Address Line | 57 PLAINS RD
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City | MILFORD
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State | CT
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Zip | 06461-2573
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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 | DIRECTOR
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Name | THEDDEUS IHEANACHO
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Credential | M.D.
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Telephone | 203-874-0593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 49777
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License Number State | CT
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