Provider Demographics
NPI:1790725588
Name:CHARTWELL SOUTHERN NEW ENGLAND, LLC
Entity Type:Organization
Organization Name:CHARTWELL SOUTHERN NEW ENGLAND, LLC
Other - Org Name:OPTION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BONACCORSI
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:847-229-7794
Mailing Address - Street 1:3026 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0030
Mailing Address - Country:US
Mailing Address - Phone:800-879-6137
Mailing Address - Fax:847-913-9024
Practice Address - Street 1:80 CLARK DR
Practice Address - Street 2:UNITE 1-A
Practice Address - City:EAST BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06023-1157
Practice Address - Country:US
Practice Address - Phone:800-755-1511
Practice Address - Fax:860-828-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1385332B00000X, 332BP3500X, 3336C0003X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004129822Medicaid
CT004131132Medicaid
CT004131132Medicaid