Provider Demographics
NPI:1619768165
Name:TRINITY WELLNESS OF CT LLC
Entity type:Organization
Organization Name:TRINITY WELLNESS OF CT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-870-1796
Mailing Address - Street 1:350 CENTER ROCK GRN STE 3
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-3170
Mailing Address - Country:US
Mailing Address - Phone:203-870-1796
Mailing Address - Fax:203-307-1771
Practice Address - Street 1:350 CENTER ROCK GRN STE 3
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-3170
Practice Address - Country:US
Practice Address - Phone:203-870-1796
Practice Address - Fax:203-307-1771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)