Provider Demographics
NPI:1700384856
Name:TRICIRCLE CORPORATION
Entity Type:Organization
Organization Name:TRICIRCLE CORPORATION
Other - Org Name:TRICIRCLE INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER, EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOPOIAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA, CPRC, RSS, CHT
Authorized Official - Phone:203-349-7074
Mailing Address - Street 1:6 WAY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06455-1080
Mailing Address - Country:US
Mailing Address - Phone:860-349-7074
Mailing Address - Fax:860-349-7032
Practice Address - Street 1:6 WAY RD
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06455-1080
Practice Address - Country:US
Practice Address - Phone:860-349-7074
Practice Address - Fax:860-349-7032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008013938Medicaid