Provider Demographics
NPI:1699134742
Name:MOUNTAINSIDE TREATMENT CENTER
Entity type:Organization
Organization Name:MOUNTAINSIDE TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL INTEGRATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-362-5051
Mailing Address - Street 1:187 S CANAAN RD
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06018-2544
Mailing Address - Country:US
Mailing Address - Phone:860-362-5051
Mailing Address - Fax:
Practice Address - Street 1:187 S CANAAN RD
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06018-2544
Practice Address - Country:US
Practice Address - Phone:860-362-5051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1181324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility