Organization · NPI-2

Connecticut Renaissance, INC.

Clinic/Center, Rehabilitation, Substance Use Disorder · Bridgeport, CT

NPI number1194069708
StatusActive
Last updated in NPPESJan 2, 2013

Details

NPI
1194069708
Entity type
Organization (NPI-2)
Legal business name
Connecticut Renaissance, INC.
Organization subpart
No
Enumeration date
Nov 20, 2012
Last updated
Jan 2, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder0442CTYes
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)0442CT

Practice location

1126 Main St
Bridgeport, CT 06604-4404

Phone 203-333-2040 · Fax 203-333-2152

Mailing address

350 Fairfield Ave
Suite 701
Bridgeport, CT 06604-6014

Phone 203-336-5225 · Fax 203-336-2851

Authorized official

Joseph B Riker
Executive Director
20333652258

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