Healthcare Provider Details

I. General information

NPI: 1164572269
Provider Name (Legal Business Name): DANBURY ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 GLEN HILL RD
DANBURY CT
06811-4985
US

IV. Provider business mailing address

8 GLEN HILL RD
DANBURY CT
06811-4985
US

V. Phone/Fax

Practice location:
  • Phone: 203-748-0506
  • Fax: 203-748-0196
Mailing address:
  • Phone: 203-748-0506
  • Fax: 203-748-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL-0054
License Number StateCT

VIII. Authorized Official

Name: MS. DIANE C THOMPSON
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 203-748-0506