Provider Demographics
NPI:1629639034
Name:MANO-EN-MANO HAND IN HAND,LLC
Entity Type:Organization
Organization Name:MANO-EN-MANO HAND IN HAND,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:REXACH
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:860-634-2514
Mailing Address - Street 1:1206 STORRS RD # 101
Mailing Address - Street 2:
Mailing Address - City:STORRS MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06268-2251
Mailing Address - Country:US
Mailing Address - Phone:860-634-2514
Mailing Address - Fax:
Practice Address - Street 1:843 MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6041
Practice Address - Country:US
Practice Address - Phone:860-634-2514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1215304746Medicaid