Basic Information
| Provider Information | |||||||||
| NPI: | 1073679445 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | APT FOUNDATION, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ORCHARD HILL TREATMENT SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1 LONG WHARF DR | ||||||||
| Address2: | SUITE 321 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065115991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037814600 | ||||||||
| FaxNumber: | 2037814624 | ||||||||
| Practice Location | |||||||||
| Address1: | 352 STATE ST | ||||||||
| Address2: | |||||||||
| City: | NORTH HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064733108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037814600 | ||||||||
| FaxNumber: | 2037814624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 02/08/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MADDEN | ||||||||
| AuthorizedOfficialFirstName: | LYNN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2037814600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MPA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | SA-0101 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 261QM2800X | SA-0101 | CT | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
ID Information
| ID | Type | State | Issuer | Description | 008058217 | 01 | CT | SEARS MEDICAID | OTHER | 008064634 | 01 | CT | GARERI MEDICAID | OTHER | 001218107 | 01 | CT | SCHOTTENFELD MEDICAID | OTHER | 008050283 | 01 | CT | HAYNES MEDICAID | OTHER | 008066315 | 01 | CT | COLON RIVERA MEDICAID | OTHER | 008038019 | 01 | CT | MEDICAID ONOFRIO | OTHER | 008038047 | 01 | CT | DIMEOLA MEDICAID | OTHER | 001423136 | 01 | CT | TETRAULT MEDICAID | OTHER | 004082286 | 01 | CT | ORC/MEDICAID/MMT | OTHER | 008038019 | 01 | CT | MEDICAID ONOFRIO | OTHER | 008053091 | 01 | CT | BUTNER MEDICAID | OTHER | 001302497 | 01 | CT | SHI MEDICAID | OTHER | 004235083 | 01 | CT | YOUNG MEDICAID | OTHER | 008037391 | 01 | CT | SHACKELL MEDICAID | OTHER | 008053715 | 01 | CT | NUNLEY MEDICAID | OTHER | 008066551 | 01 | CT | DEOLIVEIRA MEDICAID | OTHER | 500000315 | 01 | CT | ORC/MEDICAID/SA | OTHER | 008003745 | 01 | CT | DESROSIERS MEDICAID | OTHER | 008038049 | 01 | CT | PETHO MEDICAID | OTHER | 008043611 | 01 | CT | ROSS MEDICAID | OTHER | 008061077 | 01 | CT | MEDICAID VOLLONO | OTHER | 001340132 | 01 | CT | SAVAGE MEDICAID | OTHER |