Provider Demographics
NPI:1881910875
Name:AVADA OF CONNECTICUT, INC.
Entity type:Organization
Organization Name:AVADA OF CONNECTICUT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTOLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:413-733-3196
Mailing Address - Street 1:459 RIVERDALE ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4605
Mailing Address - Country:US
Mailing Address - Phone:413-733-3196
Mailing Address - Fax:413-736-1037
Practice Address - Street 1:2A PASCO DR
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06088-1705
Practice Address - Country:US
Practice Address - Phone:860-292-6801
Practice Address - Fax:860-292-6802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARING HEALTHCARE MANAGEMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT63-0000051332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment