Healthcare Provider Details

I. General information

NPI: 1518107960
Provider Name (Legal Business Name): JEWISH HOME FOR THE ELDERLY OF FAIRFIELD COUNTY INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 PARK AVE
BRIDGEPORT CT
06604
US

IV. Provider business mailing address

4200 PARK AVE
BRIDGEPORT CT
06604-1049
US

V. Phone/Fax

Practice location:
  • Phone: 203-365-6455
  • Fax:
Mailing address:
  • Phone: 203-365-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHEILA ROBINSON
Title or Position: AR SUPERVISOR
Credential:
Phone: 203-396-1075