Organization
OPERATION LIFESTYLE REDESIGN GROUP LLC
Active
Other names
Emerald Wellness, Lifestyle Redesign 77
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON DAVAR PERVIS SR. APRN (VICE PRESIDENT OF CLINICAL OPERATIO)
(203) 957-3938
Entity
Organization
Contact information
Practice address
83 WOOSTER HEIGHTS, SUITE #125, DANBURY, CT 06810
(203) 957-3938
(866) 266-4842
Mailing address
33 DIXWELL AVE STE 278, NEW HAVEN, CT 06511-3403
(203) 957-3938
(866) 266-4842
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
09/17/2021
Last updated
09/17/2021
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