Provider Demographics
NPI:1760821896
Name:UCONN CORRECTIONAL MANAGED HEALTHCARE
Entity Type:Organization
Organization Name:UCONN CORRECTIONAL MANAGED HEALTHCARE
Other - Org Name:UCONN CMHC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBER
Authorized Official - Middle Name:
Authorized Official - Last Name:TRESTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-679-5500
Mailing Address - Street 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-5386
Mailing Address - Country:US
Mailing Address - Phone:860-679-5500
Mailing Address - Fax:860-679-5552
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1956
Practice Address - Country:US
Practice Address - Phone:860-679-5500
Practice Address - Fax:860-679-5552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF CONNECTICUT HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT65282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital