Basic Information
| Provider Information | |||||||||
| NPI: | 1104184670 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | APT FOUNDATION, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | RESIDENTIAL SERVICES DIVISION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1 LONG WHARF DR | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065115991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037814600 | ||||||||
| FaxNumber: | 2037814624 | ||||||||
| Practice Location | |||||||||
| Address1: | 54 E RAMSDELL ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065151140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033379943 | ||||||||
| FaxNumber: | 2033876533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2012 | ||||||||
| LastUpdateDate: | 07/05/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | MADDEN | ||||||||
| AuthorizedOfficialFirstName: | LYNN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT, CEO | ||||||||
| AuthorizedOfficialTelephone: | 2037814600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MPA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 261QM2800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
ID Information
| ID | Type | State | Issuer | Description | 001423136 | 01 | CT | TETRAULT MEDICAID | OTHER | 008030353 | 01 | CT | FELDMAN MEDICAID | OTHER | 008037391 | 01 | CT | SHACKELL MEDICAID | OTHER | 008069619 | 01 | CT | PARISI MEDICAID | OTHER | 008038186 | 01 | CT | IEAD MEDICAID | OTHER | 008070148 | 01 | CT | BURGDORFER MEDICAID | OTHER | 008042339 | 01 | CT | RSD/MEDICAID/MMT | OTHER | 008045348 | 01 | CT | TAVERNER MEDICAID | OTHER | 008003745 | 01 | CT | DESROSIERS MEDICAID | OTHER | 001302497 | 01 | CT | SHI MEDICAID | OTHER | 008023170 | 01 | CT | WILLIAMS MEDICAID | OTHER | 008053091 | 01 | CT | BUTNER MEDICAID | OTHER | 008058232 | 01 | CT | ANDERSON MEDICAID | OTHER | 001340132 | 01 | CT | SAVAGE MEDICAID | OTHER | 008056047 | 01 | CT | ROSS MEDICAID | OTHER |