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CONNECTICUT VALLEY ADDICTION RECOVERY, INC
Complete NPI Record 1750932646
Internal Medicine - Addiction Medicine in Windsor, VT

NPI Status: Active since September 23, 2019

Contact Information

141 ETTA FRASIER DR
WINDSOR, VT
ZIP 05089
Phone: (802) 674-9400

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider First Line Business Practice Location Address
  11. Provider Business Practice Location Address City Name
  12. Provider Business Practice Location Address State Name
  13. Provider Business Practice Location Address Postal Code
  14. Provider Business Practice Location Address Country Code If outside U S
  15. Provider Business Practice Location Address Telephone Number
  16. Provider Enumeration Date
  17. Last Update Date
  18. Authorized Official Last Name
  19. Authorized Official First Name
  20. Authorized Official Middle Name
  21. Authorized Official Title or Position
  22. Authorized Official Telephone Number
  23. Healthcare Provider Taxonomy Code 1
  24. Healthcare Provider Primary Taxonomy Switch 1
  25. Is Organization Subpart
  26. Authorized Official Name Prefix Text
  27. Authorized Official Credential Text
  28. Healthcare Provider Taxonomy Group 1

Complete NPI Dataset

This page represents the complete record for NPI 1750932646. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1750932646
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 141 ETTA FRASIER DR
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: WINDSOR
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: VT
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 050891315
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider First Line Business Practice Location Address: 141 ETTA FRASIER DR
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: WINDSOR
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: VT
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 050891315
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 8026749400
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 9/23/2019
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 9/23/2019
The date that a record was last updated or changed.
Authorized Official Last Name: LORD
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: CLIFTON
The first name of the authorized official.
Authorized Official Middle Name: F
The middle name of the authorized official.
Authorized Official Title or Position: MEDICAL DIRECTOR
The title or position of the authorized official.
Authorized Official Telephone Number: 8026749400
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 207RA0401X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Authorized Official Name Prefix Text: DR.
Authorized Official Credential Text: MD
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP