Provider Demographics
NPI:1174397467
Name:CONNECTICUT INFUSION NURSES LLC
Entity type:Organization
Organization Name:CONNECTICUT INFUSION NURSES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-415-1542
Mailing Address - Street 1:597 WOODHOUSE AVE
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-5450
Mailing Address - Country:US
Mailing Address - Phone:203-415-1542
Mailing Address - Fax:
Practice Address - Street 1:597 WOODHOUSE AVE
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-5450
Practice Address - Country:US
Practice Address - Phone:203-415-1542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility