Provider Demographics
NPI:1447072988
Name:SANA2 COLITA ADULT BEHAVIORAL HEALTH RX. TREATMENT & WELLNESS REFUGE
Entity type:Organization
Organization Name:SANA2 COLITA ADULT BEHAVIORAL HEALTH RX. TREATMENT & WELLNESS REFUGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-503-0960
Mailing Address - Street 1:433 SILAS DEANE HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2123
Mailing Address - Country:US
Mailing Address - Phone:860-503-0960
Mailing Address - Fax:
Practice Address - Street 1:433 SILAS DEANE HWY STE 2
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2123
Practice Address - Country:US
Practice Address - Phone:860-503-0960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty