Provider Demographics
NPI:1912448465
Name:SANFORD LINN LLC
Entity Type:Organization
Organization Name:SANFORD LINN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-748-2222
Mailing Address - Street 1:29 THE LAURELS
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-2349
Mailing Address - Country:US
Mailing Address - Phone:860-748-2222
Mailing Address - Fax:860-506-7818
Practice Address - Street 1:4 WEST RD
Practice Address - Street 2:#6
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-4247
Practice Address - Country:US
Practice Address - Phone:860-967-0601
Practice Address - Fax:888-709-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002192363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty