Provider Demographics
NPI:1649395781
Name:YALE NEW HAVEN AMBULATORY SERVICES CORP
Entity Type:Organization
Organization Name:YALE NEW HAVEN AMBULATORY SERVICES CORP
Other - Org Name:TEMPLE RECOVERY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-688-1311
Mailing Address - Street 1:229 GEORGE STREET
Mailing Address - Street 2:FLOOR 3
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510
Mailing Address - Country:US
Mailing Address - Phone:203-498-3203
Mailing Address - Fax:203-498-3107
Practice Address - Street 1:229 GEORGE STREET
Practice Address - Street 2:FLOOR 3
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-498-3203
Practice Address - Fax:203-498-3107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0002313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility