Provider Demographics
NPI:1396050209
Name:NORTH STONINGTON HEALTH CENTER, INC
Entity type:Organization
Organization Name:NORTH STONINGTON HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LACHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-348-3711
Mailing Address - Street 1:183 PROVIDENCE NEW LONDON TPKE # E8
Mailing Address - Street 2:
Mailing Address - City:NORTH STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06359-1721
Mailing Address - Country:US
Mailing Address - Phone:860-535-2273
Mailing Address - Fax:860-535-0204
Practice Address - Street 1:183 PROVIDENCE NEW LONDON TPKE # E8
Practice Address - Street 2:
Practice Address - City:NORTH STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06359-1721
Practice Address - Country:US
Practice Address - Phone:860-535-2273
Practice Address - Fax:860-535-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 208D00000X
CTCL-0676291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory