Organization Name:  CHARTWELL SOUTHERN NEW ENGLAND, LLC


Practice Location:
80 CLARK DR UNITE 1-A EAST BERLIN, CT 06023 US
Tel: 800-755-1511  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	332BP3500X	Suppliers Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition	CT	1385
N	3336C0003X	Suppliers Pharmacy	CT	1385
N	332B00000X	Suppliers Durable Medical Equipment & Medical Supplies	CT	1385
Y	3336H0001X	Suppliers Pharmacy	CT	1385

Other Provider Identifiers:

Issuer	Number	State	Type
	004129822	CT	05
	004131132	CT	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin