Provider Demographics
NPI:1073143152
Name:CONNECTICUT CENTER FOR RECOVERY, LLC
Entity Type:Organization
Organization Name:CONNECTICUT CENTER FOR RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-350-3100
Mailing Address - Street 1:177 W PUTNAM AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-5203
Mailing Address - Country:US
Mailing Address - Phone:203-350-3100
Mailing Address - Fax:203-418-7500
Practice Address - Street 1:177 W PUTNAM AVE FL 1
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5203
Practice Address - Country:US
Practice Address - Phone:203-350-3100
Practice Address - Fax:203-418-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility