Healthcare Provider Details

I. General information

NPI: 1285962928
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: 11/18/2009
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 PARK AVE
BRIDGEPORT CT
06604-1049
US

IV. Provider business mailing address

4200 PARK AVE
BRIDGEPORT CT
06604-1049
US

V. Phone/Fax

Practice location:
  • Phone: 203-365-6400
  • Fax:
Mailing address:
  • Phone: 203-365-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

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