Healthcare Provider Details

I. General information

NPI: 1659439057
Provider Name (Legal Business Name): WINTONBURY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 PARK AVE
BLOOMFIELD CT
06002-3207
US

IV. Provider business mailing address

140 PARK AVE
BLOOMFIELD CT
06002-3207
US

V. Phone/Fax

Practice location:
  • Phone: 860-243-9591
  • Fax: 860-286-0161
Mailing address:
  • Phone: 860-243-9591
  • Fax: 860-286-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2221-C
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000010876
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer
# 2
Identifier728
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerBC/BS

VIII. Authorized Official

Name: MR. CHRISTOPHER S WRIGHT
Title or Position: MANAGER
Credential:
Phone: 860-570-2140