Provider Demographics
NPI:1245501279
Name:CT FAMILY CARE LLC
Entity type:Organization
Organization Name:CT FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHLER-AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-BC
Authorized Official - Phone:860-985-7080
Mailing Address - Street 1:281 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4784
Mailing Address - Country:US
Mailing Address - Phone:860-454-8621
Mailing Address - Fax:860-926-4725
Practice Address - Street 1:281 HARTFORD TPKE
Practice Address - Street 2:SUITE 306
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4784
Practice Address - Country:US
Practice Address - Phone:860-454-8621
Practice Address - Fax:860-926-4725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty