Organization · Type 2 NPI

Operation Lifestyle Redesign Group LLC

Mental Health Clinic/Center (Including Community Mental Health Center) · Danbury, CT

NPI number 1972273282 Active

Practice location

83 Wooster Heights, Suite #125
Danbury, CT 06810

Call (203) 957-3938 Map

Fax (866) 266-4842

Mailing address

33 Dixwell Ave Ste 278
New Haven, CT 06511-3403

Specialties and licenses

Taxonomy	Code	License
Mental Health Clinic/Center (Including Community Mental Health Center) Primary	261QM0801X	None listed
Multi-Specialty Clinic/Center	261QM1300X	None listed
Primary Care Clinic/Center	261QP2300X	None listed

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NPI record

NPI: 1972273282
Entity type: Organization (Type 2)
Issued: Sep 17, 2021
Last updated: Sep 17, 2021
Status: Active

Other names

Emerald Wellness · doing business as
Lifestyle Redesign 77 · doing business as

Authorized official

Mr. Brandon Davar Pervis, APRN
Vice President of Clinical Operatio
(203) 957-3938

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1972273282

Operation Lifestyle Redesign Group LLC's National Provider Identifier is 1972273282, issued on Sep 17, 2021. The primary taxonomy on file is Mental Health Clinic/Center (Including Community Mental Health Center) (261QM0801X), and the practice location is in Danbury, CT. The record was last updated on Sep 17, 2021.