Provider Demographics
NPI:1346639739
Name:CENTER FOR TRANSITIONAL LIVING
Entity Type:Organization
Organization Name:CENTER FOR TRANSITIONAL LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY/BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-840-7285
Mailing Address - Street 1:6 EXECUTIVE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2853
Mailing Address - Country:US
Mailing Address - Phone:860-840-7285
Mailing Address - Fax:860-920-7369
Practice Address - Street 1:57 PRATT ST FL 6
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-1604
Practice Address - Country:US
Practice Address - Phone:860-840-7285
Practice Address - Fax:860-920-7369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008065395Medicaid
CT008059342Medicaid