1962405720 NPI number — HEALTH CARE VENTURES INC DBA CRESCENT MANOR

Table of content: DR. JOSHUA STEVEN HALES MD (NPI 1205459237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962405720 NPI number — HEALTH CARE VENTURES INC DBA CRESCENT MANOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH CARE VENTURES INC DBA CRESCENT MANOR
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:
6
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:
1962405720
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:
1157 HIGHLAND AVE
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
CHESHIRE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06410-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-250-2030
Provider Business Mailing Address Fax Number:
203-250-2034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1243 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06708-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-757-0561
Provider Business Practice Location Address Fax Number:
203-755-5998
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HARRISON
Authorized Official First Name:
GLADYS
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
203-250-2030

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2156C , 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)





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