Connecticut Renaissance, Inc.

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

0332 Issued in CT

Legal business name

CONNECTICUT RENAISSANCE, INC.

Practice address

1120 Main St
Bridgeport, CT 06604-4404

Phone

(203) 367-6827

Fax

(203) 367-7576

NPI assigned

Aug 2, 2006

Last updated

Jun 9, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Patrick McAuliffe, MBA, LADC

Title

Ceo

Phone

(203) 336-5225

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Other NPIs on the same Medicare enrollment 5

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

• Connecticut Renaissance, Inc

  dba CT Renaissance

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Norwalk, CT
  • NPI 1265449359

  O20050222000611

  Same enrollment
• Connecticut Renaissance, Inc.

  dba CT Renaissance

  • Substance Abuse Rehabilitation Facility
  • Waterbury, CT
  • NPI 1669617973

  O20050222000611

  Same enrollment
• Connecticut Renaissance, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Waterbury, CT
  • NPI 1700352721

  O20050222000611

  Same enrollment
• Connecticut Renaissance, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Stamford, CT
  • NPI 1700893807

  O20050222000611

  Same enrollment
• Connecticut Renaissance, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Bridgeport, CT
  • NPI 1720130362

  O20050222000611

  Same enrollment

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433808000000",
    "number": "1740297845",
    "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": "203-336-2851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066044404",
            "telephone_number": "203-367-6827",
            "fax_number": "203-367-7576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT RENAISSANCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2015-06-09",
        "status": "A",
        "authorized_official_last_name": "MCAULIFFE",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "203-336-5225",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA, LADC"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "CT",
            "license": "0332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004228575",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Connecticut Neurosurgical Specialists, P.C.
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• Connecticut Renaissance, Inc.
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• Connecticut Renaissance, Inc.
• Connecticut Spine & Rehab, LLC
• Katharine Bernadette Connolly, MS, PA-C
• Katherine L Connor, LCSW
• Rosabelle Therese Conover, APRN
• Pamela Conrad

• Substance Use Disorder Rehabilitation Clinic/Center in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2015; 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.