NEW ERA REHABILITATION CENTER INC NPI 1255372108

NPI Information

NPI: 1255372108
Provider Name: NEW ERA REHABILITATION CENTER, INC
Classification: Clinic/Center - 261QM2800X
Entity Type: Organization

Specialization: Methadone

CLIA Number: 07D2225712

Address:
4675 MAIN STREET
BRIDGEPORT, CT
ZIP 06606
Phone: (203) 344-0025
Get Directions

NEW ERA REHABILITATION CENTER, INC is a methadone clinic center in Bridgeport, CT. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. NEW ERA REHABILITATION CENTER, INC NPI is 1255372108. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4675 MAIN STREET
BRIDGEPORT, CT
ZIP 06606-864
Phone: (203) 344-0025
Fax: (203) 374-7515

The provider's authorized official is Ebenezer Adekunle Kolade .
The authorized official title is Executive Director and has the following contact phone number (203) 562-2101.

The CLIA number assigned to this NPI record is 07D2225712 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/10/2006 and was last updated on 5/12/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	204D00000X	Neuromusculoskeletal Medicine & OMM		042947	CONNECTICUT	No
2	207QA0401X	Family Medicine	Addiction Medicine	042947	CONNECTICUT	No
3	207RA0401X	Internal Medicine	Addiction Medicine	040029	CONNECTICUT	No
4	261QM0850X	Clinic/Center	Adult Mental Health			No
5	261QM2800X	Clinic/Center	Methadone	0266	CONNECTICUT	Yes
6	261QR0401X	Clinic/Center	Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)	0266	CONNECTICUT	No
7	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	0266	CONNECTICUT	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	4224507	MEDICAID	CONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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