Provider Demographics
NPI:1346812344
Name:RESONANT CAPITAL LLC
Entity Type:Organization
Organization Name:RESONANT CAPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-333-7654
Mailing Address - Street 1:1 E SHORE AVE
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-8837
Mailing Address - Country:US
Mailing Address - Phone:860-333-7654
Mailing Address - Fax:
Practice Address - Street 1:1 E SHORE AVE
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-8837
Practice Address - Country:US
Practice Address - Phone:860-333-7654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health