Healthcare Provider Details

I. General information

NPI: 1073573317
Provider Name (Legal Business Name): BRISTOL CCH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 STAFFORD AVE
BRISTOL CT
06010-2571
US

IV. Provider business mailing address

1660 STAFFORD AVE
BRISTOL CT
06010-2571
US

V. Phone/Fax

Practice location:
  • Phone: 860-583-8483
  • Fax: 860-585-7913
Mailing address:
  • Phone: 860-583-8483
  • Fax: 860-585-7913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2285
License Number StateCT

VIII. Authorized Official

Name: LAWRENCE G. SANTILLI
Title or Position: MANAGER
Credential:
Phone: 860-751-3900