Provider Demographics
NPI:1922539592
Name:CTUC01
Entity Type:Organization
Organization Name:CTUC01
Other - Org Name:AFC URGENTCARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SITE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-826-2600
Mailing Address - Street 1:179 TALCOTTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:179 TALCOTTVILLE RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066
Practice Address - Country:US
Practice Address - Phone:860-986-7600
Practice Address - Fax:860-986-7601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW DIMENSION HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-24
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care