Provider Demographics
NPI:1003788233
Name:MEDITOX CARE, LLC
Entity type:Organization
Organization Name:MEDITOX CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSAMRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-887-3890
Mailing Address - Street 1:5 HARBOR PKWY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-2606
Mailing Address - Country:US
Mailing Address - Phone:203-450-4882
Mailing Address - Fax:
Practice Address - Street 1:5 HARBOR PKWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2606
Practice Address - Country:US
Practice Address - Phone:203-450-4882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDITOX CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility