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General NPI Number Information
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NPI Number | 1811574064
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Entity Type | Organization
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Legal Business Name | SB TRANSITIONAL SUB, LLC
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 101 SOUTH ST FL 2
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City | WEST HARTFORD
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State | CT
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Zip | 06110-1967
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Country | US
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Telephone | 508-521-2856
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Fax |
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Provider Business Mailing Address
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Address Line | 101 SOUTH ST FL 2
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City | WEST HARTFORD
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State | CT
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Zip | 06110-1967
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Country | US
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Telephone | 508-521-2856
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Fax |
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Authorized Official
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Title or Position | VP& SR. ASST. GENERAL COUNSEL
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Name | MARY PATRICIA RODENBERG-ROBERTS
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Credential |
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Telephone | 952-836-2234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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