Basic Information
| Provider Information | |||||||||
| NPI: | 1780987099 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | APT FOUNDATION INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | LEGION CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1 LONG WHARF DR | ||||||||
| Address2: | STE 321 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065115991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037814600 | ||||||||
| FaxNumber: | 2037814624 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 LONG WHARF DR | ||||||||
| Address2: | STE 321 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065115991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037814600 | ||||||||
| FaxNumber: | 2037814624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2010 | ||||||||
| LastUpdateDate: | 02/21/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MADDEN | ||||||||
| AuthorizedOfficialFirstName: | LYNN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| 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 | 0230 | CT | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 008003745 | 01 | CT | DESROSIERS MEDICAID | OTHER | 008038037 | 01 | CT | EGGERT MEDICAID | OTHER | 008038052 | 01 | CT | NODELMAN MEDICAID | OTHER | 008070113 | 05 | CT | MEDICAID | 001218107 | 01 | CT | SCHOTTENFELD MEDICAID | OTHER | 008001325 | 01 | CT | LEGION/MEDICAID/SA | OTHER | 008045323 | 01 | CT | GARCIA MEDICAID | OTHER | 008061961 | 01 | CT | SMALL-OIE MEDICAID | OTHER | 008037391 | 01 | CT | SHACKELL MEDICAID | OTHER | 001302497 | 01 | CT | SHI MEDICAID | OTHER | 001423136 | 01 | CT | TETRAULT MEDICAID | OTHER | 008038053 | 01 | CT | ROEHRICH MEDICAID | OTHER | 008053091 | 01 | CT | BUTNER MEDICAID | OTHER | 008069472 | 01 | CT | POTWARDOWSKI MEDICAID | OTHER | 008066293 | 01 | CT | MARDAM BEY MEDICAID | OTHER | 001340132 | 01 | CT | SAVAGE MEDICAID | OTHER | 008048393 | 01 | CT | BARRY MEDICAID | OTHER | 008050785 | 01 | CT | DROZD MEDICAID | OTHER |