| Staywell Health Care Inc/g.w. Mental/auth | |
|
95 Thomaston Ave Waterbury CT 06702-1007 | |
| (203) 756-8021 | |
| (203) 805-4913 |
| Full Name | Staywell Health Care Inc/g.w. Mental/auth |
|---|---|
| Speciality | Family Medicine |
| Location | 95 Thomaston Ave, Waterbury, Connecticut |
| Authorized Official Name and Position | Donald Thompson (PRESIDENT) |
| Authorized Official Contact | 2037568021 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Staywell Health Care Inc/g.w. Mental/auth 80 Phoenix Ave Ste 201 Waterbury CT 06702-1418 Ph: (203) 756-8021 | Staywell Health Care Inc/g.w. Mental/auth 95 Thomaston Ave Waterbury CT 06702-1007 Ph: (203) 756-8021 |
| NPI Number | 1033366240 |
|---|---|
| Provider Enumeration Date | 08/20/2008 |
| Last Update Date | 01/09/2020 |
| Medicare PECOS PAC ID | 6305750480 |
|---|---|
| Medicare Enrollment ID | O20070608000584 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033366240 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary |
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