Provider Demographics
NPI:1982498200
Name:THE MOHEGAN TRIBE OF INDIANS OF CONNECTICUT
Entity type:Organization
Organization Name:THE MOHEGAN TRIBE OF INDIANS OF CONNECTICUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE HEALTH AND WELFARE OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-862-6145
Mailing Address - Street 1:13 CROW HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-1118
Mailing Address - Country:US
Mailing Address - Phone:860-862-6102
Mailing Address - Fax:
Practice Address - Street 1:13 CROW HILL RD
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-1118
Practice Address - Country:US
Practice Address - Phone:860-862-6102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health