Provider Demographics
NPI:1083883177
Name:MOUNTAINSIDE TREATMENT CENTER
Entity Type:Organization
Organization Name:MOUNTAINSIDE TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-362-5232
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06018
Mailing Address - Country:US
Mailing Address - Phone:860-824-1397
Mailing Address - Fax:888-789-2815
Practice Address - Street 1:187 ROUTE 7
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06018
Practice Address - Country:US
Practice Address - Phone:860-824-1397
Practice Address - Fax:860-824-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTSA0187324500000X
CT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility