Provider Demographics
NPI:1184374993
Name:NR CONNECTICUT, LLC
Entity type:Organization
Organization Name:NR CONNECTICUT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROGODSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-444-3512
Mailing Address - Street 1:915 ELLA T GRASSO BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-5516
Mailing Address - Country:US
Mailing Address - Phone:203-349-9400
Mailing Address - Fax:800-915-6119
Practice Address - Street 1:915 ELLA T GRASSO BLVD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-5516
Practice Address - Country:US
Practice Address - Phone:561-444-3512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-25
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder