Provider Demographics
NPI:1851016661
Name:INTEGRATED CARE OF CONNECTICUT LLC
Entity Type:Organization
Organization Name:INTEGRATED CARE OF CONNECTICUT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:YUNCHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-758-2300
Mailing Address - Street 1:850 STRAITS TPKE STE 203
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-2843
Mailing Address - Country:US
Mailing Address - Phone:203-758-2300
Mailing Address - Fax:203-758-9300
Practice Address - Street 1:850 STRAITS TPKE STE 203
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2843
Practice Address - Country:US
Practice Address - Phone:203-758-2300
Practice Address - Fax:203-758-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health