Basic Information
Provider Information | |||||||||
NPI: | 1336205905 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | APT FOUNDATION, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | APT RESIDENTIAL SERVICES DIVISION (RSD) | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
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: | 54 E RAMSDELL ST | ||||||||
Address2: |   | ||||||||
City: | NEW HAVEN | ||||||||
State: | CT | ||||||||
PostalCode: | 065151140 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2033379943 | ||||||||
FaxNumber: | 2033876533 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/28/2006 | ||||||||
LastUpdateDate: | 07/05/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MADDEN | ||||||||
AuthorizedOfficialFirstName: | LYNN | ||||||||
AuthorizedOfficialMiddleName: | M | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
AuthorizedOfficialTelephone: | 2037814640 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MPA | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic | 324500000X |   |   | Y |   | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |   |
ID Information
ID | Type | State | Issuer | Description | 008056047 | 01 | CT | ROSS MEDICAID | OTHER | 001423136 | 01 | CT | TETRAULT MEDICAID | OTHER | 008003745 | 01 | CT | DESROSIERS MEDICAID | OTHER | 008030353 | 01 | CT | FELDMAN MEDICAID | OTHER | 008038188 | 01 | CT | REILLY MEDICAID | OTHER | 008023170 | 01 | CT | WILLIAMS MEDICAID | OTHER | 008037391 | 01 | CT | SHACKELL MEDICAID | OTHER | 008038186 | 01 | CT | IEAD MEDICAID | OTHER | 008045348 | 01 | CT | TAVERNER MEDICAID | OTHER | 008070148 | 01 | CT | BURGDORFER MEDICAID | OTHER | 001340132 | 01 | CT | SAVAGE MEDICAID | OTHER | 001302497 | 01 | CT | SHI MEDICAID | OTHER | 008058232 | 01 | CT | ANDERSON MEDICAID | OTHER | 008053091 | 01 | CT | BUTNER MEDICAID | OTHER | 008069619 | 01 | CT | PARISI MEDICAID | OTHER |