NPIMap

Organization Active NPI

Connecticut Renaissance, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Bridgeport, CT
National Provider Identifier
1720130362
Registry record updated Dec 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
0350 Issued in CT
Legal business name
CONNECTICUT RENAISSANCE, INC.
Practice address
1126 Main St
Bridgeport, CT 06604-4404
Phone
(203) 368-9755
Fax
(203) 368-9760
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2022

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

Authorized official

Name
Dawn E Patston, LMFTNPI 1508137381
Title
Coo
Phone
(203) 336-5225

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 0412 CT
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 0350 CT Primary

Addresses

Primary practice location

1126 Main St
Bridgeport, CT 06604-4404

Mailing address

1 Waterview Dr Ste 202
Shelton, CT 06484-4368
Phone (203) 336-5225

Other identifiers 1

IdentifierTypeStateIssuer
008002559MedicaidCT

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
This NPI is an additional NPI on the 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
Tax ID family
Connecticut Renaissance Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

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": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669939200000",
    "number": "1720130362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WATERVIEW DR STE 202",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064844368",
            "telephone_number": "203-336-5225",
            "fax_number": "203-336-2851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1126 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066044404",
            "telephone_number": "203-368-9755",
            "fax_number": "203-368-9760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT RENAISSANCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A",
        "authorized_official_last_name": "PATSTON",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "203-336-5225",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CT",
            "license": "0412",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "CT",
            "license": "0350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008002559",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; 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.