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General NPI Number Information
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NPI Number | 1760821896
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Entity Type | Organization
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Legal Business Name | UCONN CORRECTIONAL MANAGED HEALTHCARE
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 263 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06032-1956
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Country | US
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Telephone | 860-679-5500
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Fax | 860-679-5552
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Provider Business Mailing Address
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Address Line | 263 FARMINGTON AVENUE
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City | FARMINGTON
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State | CT
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Zip | 06032-5386
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Country | US
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Telephone | 860-679-5500
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Fax | 860-679-5552
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Authorized Official
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Title or Position | CEO
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Name | DR. ROBER TRESTMAN
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Credential | MD
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Telephone | 860-679-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 65
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License Number State | CT
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