1538225909 NPI number — CHESTNUT POINT CARE CENTER LLC

Table of content: (NPI 1538225909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538225909 NPI number — CHESTNUT POINT CARE CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESTNUT POINT CARE CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TOUCHPOINTS AT CHESTNUT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538225909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
171 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST WINDSOR
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06088-9682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-292-5394
Provider Business Mailing Address Fax Number:
860-623-7928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
171 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST WINDSOR
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06088-9682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-292-5394
Provider Business Practice Location Address Fax Number:
860-623-7928
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
S
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
860-570-2140

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2314 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000090209 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74A . This is a "BC/BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1429528 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 912950 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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