| Eastern Services & Camp Simon, Llc | |
|
115 Bridge St Suite C East Windsor CT 06088-9547 | |
| (860) 254-5127 | |
| (860) 254-5254 |
| Full Name | Eastern Services & Camp Simon, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 115 Bridge St, East Windsor, Connecticut |
| Authorized Official Name and Position | Maly Phimvongsa (DIRECTOR) |
| Authorized Official Contact | 8602545127 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastern Services & Camp Simon, Llc 115 Bridge St Suite C East Windsor CT 06088-9547 Ph: (860) 254-5127 | Eastern Services & Camp Simon, Llc 115 Bridge St Suite C East Windsor CT 06088-9547 Ph: (860) 254-5127 |
| NPI Number | 1902173370 |
|---|---|
| Provider Enumeration Date | 11/29/2011 |
| Last Update Date | 02/11/2020 |
| Certification Date | 02/11/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902173370 | NPI | - | NPPES |
| 004257053 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 001470 (Connecticut) | Primary |
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