| Living Spring Llc | |
|
203 Broad St Milford CT 06460-4751 | |
| (516) 513-2082 | |
| Not Available |
| Full Name | Living Spring Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 203 Broad St, Milford, Connecticut |
| Authorized Official Name and Position | Theddeus Iheanacho (DIRECTOR) |
| Authorized Official Contact | 5165132082 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Spring Llc 203 Broad St Milford CT 06460-4751 Ph: () - | Living Spring Llc 203 Broad St Milford CT 06460-4751 Ph: (516) 513-2082 |
| NPI Number | 1043584535 |
|---|---|
| Provider Enumeration Date | 02/29/2012 |
| Last Update Date | 02/29/2012 |
| Medicare PECOS PAC ID | 7416187976 |
|---|---|
| Medicare Enrollment ID | O20140228000589 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043584535 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 49777 (Connecticut) | Primary |
| Provider Name | Theddeus Iheanacho |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922312503 PECOS PAC ID: 3779751300 Enrollment ID: I20120202000742 |
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