NPIMap

Organization Active NPI

Connecticut Renaissance, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Stamford, CT
National Provider Identifier
1700893807
Registry record updated Jul 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
SA-0188 Issued in CT
Legal business name
CONNECTICUT RENAISSANCE, INC.
Practice address
141 Franklin St
Stamford, CT 06901-1014
Phone
(203) 602-4441
Fax
(203) 602-7782
NPI assigned
Aug 2, 2006
Last updated
Jul 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joy Nicole Pendola
Title
Coo
Phone
(203) 336-5225

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X C-0266 CT
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X SA-0188 CT Primary

Addresses

Primary practice location

141 Franklin St
Stamford, CT 06901-1014

Mailing address

350 Fairfield Ave
Suite 701
Bridgeport, CT 06604-6014
Phone (203) 336-5225

Other identifiers 1

IdentifierTypeStateIssuer
004214277MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050222000611 CT Part B Supplier - Clinic/Group Practice 0941253728 Receives reassigned benefits from 8 practitioners
5 other NPIs on this enrollment
Practice locations: Norwalk, CT; Shelton, CT; Waterbury, CT

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562544000000",
    "number": "1700893807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 FAIRFIELD AVE",
            "address_2": "SUITE 701",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066046014",
            "telephone_number": "203-336-5225",
            "fax_number": "203-226-2851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 FRANKLIN ST",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069011014",
            "telephone_number": "203-602-4441",
            "fax_number": "203-602-7782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT RENAISSANCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2019-07-08",
        "status": "A",
        "authorized_official_last_name": "PENDOLA",
        "authorized_official_first_name": "JOY",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "203-336-5225"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CT",
            "license": "C-0266",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "CT",
            "license": "SA-0188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004214277",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stamford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.