Healthcare Provider Details

I. General information

NPI: 1326253220
Provider Name (Legal Business Name): PASTIMES ADULT DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 MAIN ST
DEEP RIVER CT
06417-2049
US

IV. Provider business mailing address

423 MAIN ST
DEEP RIVER CT
06417-2049
US

V. Phone/Fax

Practice location:
  • Phone: 860-526-4342
  • Fax: 860-526-9887
Mailing address:
  • Phone: 860-526-4342
  • Fax: 860-526-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN ANN BEATY
Title or Position: OWNER - DIRECTOR
Credential: R.N.
Phone: 860-526-4342