Provider Demographics
NPI:1083209092
Name:DAVA HEALTHCARE L.L.C
Entity Type:Organization
Organization Name:DAVA HEALTHCARE L.L.C
Other - Org Name:DAVA HEALTHCARE L.L.C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PESCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-538-4571
Mailing Address - Street 1:110 OLD WOOD RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-3762
Mailing Address - Country:US
Mailing Address - Phone:860-365-6397
Mailing Address - Fax:
Practice Address - Street 1:110 OLD WOOD RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-3762
Practice Address - Country:US
Practice Address - Phone:860-365-6397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder