Provider Demographics
NPI:1780919951
Name:NEW ERA REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:NEW ERA REHABILITATION CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EBENEZER
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOLADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-562-2101
Mailing Address - Street 1:311 EAST STREET
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5838
Mailing Address - Country:US
Mailing Address - Phone:203-562-2101
Mailing Address - Fax:203-562-2102
Practice Address - Street 1:311 EAST STREET
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5838
Practice Address - Country:US
Practice Address - Phone:203-562-2101
Practice Address - Fax:203-562-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0381261QM2800X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
261QM0201XOtherTAXONOMY
CT008004032Medicaid
CTF41823Medicare UPIN