Organization
NEW CANAAN GROUP HOME INC
Active
Other names
South Avenue Cottage
Organization subpart
No
Provider details
NPI number
Authorized official
KATIE J BANZHAF (EXECUTIVE DIRECTOR)
(203) 846-9581
Entity
Organization
Contact information
Practice address
162 SOUTH AVE, NEW CANAAN, CT 06840-5728
(203) 846-9581
(203) 847-0545
Mailing address
162 SOUTH AVE, NEW CANAAN, CT 06840-5728
(203) 846-9581
(203) 847-0545
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002900
DDS LICENSE NUMBER
CT
Enumeration date
07/16/2020
Last updated
07/16/2020
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