Healthcare Provider Details

I. General information

NPI: 1083601058
Provider Name (Legal Business Name): TI - CROMWELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 MAIN ST
CROMWELL CT
06416-2308
US

IV. Provider business mailing address

385 MAIN ST
CROMWELL CT
06416-2308
US

V. Phone/Fax

Practice location:
  • Phone: 860-636-5613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1025C
License Number StateCT

VIII. Authorized Official

Name: JOSEPH C TUTERA
Title or Position: OPERATOR
Credential:
Phone: 816-444-0900