Organization
CHARTWELL SOUTHERN NEW ENGLAND, LLC
Active
Other names
Option Care
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH BONACCORSI JD (MANAGING MEMBER)
(847) 229-7794
Entity
Organization
Contact information
Practice address
80 CLARK DR, UNITE 1-A, EAST BERLIN, CT 06023-1157
(800) 755-1511
(860) 828-0029
Mailing address
3026 PAYSPHERE CIR, CHICAGO, IL 60674-0030
(800) 879-6137
(847) 913-9024
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
1385
CT
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
1385
CT
3336C0003X
Community/Retail Pharmacy
1385
CT
3336H0001X
Home Infusion Therapy Pharmacy
Primary
1385
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004129822
—
CT
05
—
004131132
—
CT
Enumeration date
06/08/2006
Last updated
01/19/2009
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