1437167707 NPI number — CONNECTICUT ELDER CARE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437167707 NPI number — CONNECTICUT ELDER CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTICUT ELDER CARE 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:
Provider Other Organization Name Type Code:
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:
1437167707
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6532 ROUTE 82
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STANFORDVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12581-5702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-868-7366
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 S CANAAN RD
Provider Second Line Business Practice Location Address:
GEER NURSING AND REHAB CENTER
Provider Business Practice Location Address City Name:
CANAAN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06018-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-824-5137
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHULHOFF
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
845-868-7366

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  002806 , 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)