MEDICARE: TOWN OF BERLIN OFFICE OF THE TREASU RER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	C-804010	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	702016-01	OTHER	CT	MD HEALTH
2	782127	OTHER	CT	AETNA US HEALTHCARE
3	A785612	OTHER	CT	OXFORD
4	702016	OTHER	CT	CONNECTICARE
5	60-00077	OTHER	CT	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1124021928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN OF BERLIN OFFICE OF THE TREASU RER

Provider Business Mailing Address
First Line	:	240 KENSINGTON RD
Second Line	:	STE 12
City	:	BERLIN
State	:	CT
Zip	:	06037-2655
Country	:	US
Telephone Number	:	860-828-7030
Fax Number	:	860-828-7420

Provider Business Practice Location Address
First Line	:	240 KENSINGTON RD
Second Line	:	STE 12
City	:	BERLIN
State	:	CT
Zip	:	06037-2655
Country	:	US
Telephone Number	:	860-828-7030
Fax Number	:	860-828-7420

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. LINDA COLELLA
Credential	:
Telephone Number	:	860-828-7030

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/08/2017

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