| Wya Homeless Hospitality | |
|
730 State Pier Rd New London CT 06320-5862 | |
| (860) 439-1573 | |
| Not Available |
| Full Name | Wya Homeless Hospitality |
|---|---|
| Speciality | Clinic/Center |
| Location | 730 State Pier Rd, New London, Connecticut |
| Authorized Official Name and Position | Margaret Flinter (SVP/CLINICAL DIRECTOR) |
| Authorized Official Contact | 8603476971 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wya Homeless Hospitality 575 Main St Fl 2 Attn: Credentialing Dpt Middletown CT 06457-2845 Ph: (860) 347-6971 | Wya Homeless Hospitality 730 State Pier Rd New London CT 06320-5862 Ph: (860) 439-1573 |
| NPI Number | 1548677982 |
|---|---|
| Provider Enumeration Date | 07/17/2014 |
| Last Update Date | 07/17/2014 |
| Medicare PECOS PAC ID | 0547169138 |
|---|---|
| Medicare Enrollment ID | O20210728003458 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548677982 | NPI | - | NPPES |
| 004236338 | Medicaid | CT | |
| 004236346 | Medicaid | CT | |
| 004236354 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | OPCC-23 (Connecticut) | Primary |
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