Healthcare Provider Details

I. General information

NPI: 1801954219
Provider Name (Legal Business Name): KETTLE BROOK CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 PROSPECT HILL RD
EAST WINDSOR CT
06088-9668
US

IV. Provider business mailing address

96 PROSPECT HILL RD
EAST WINDSOR CT
06088-9668
US

V. Phone/Fax

Practice location:
  • Phone: 860-623-9846
  • Fax: 860-292-1887
Mailing address:
  • Phone: 860-623-9846
  • Fax: 860-292-1887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2219-C
License Number StateCT

VIII. Authorized Official

Name: MR. CHRISTOPHER S WRIGHT
Title or Position: MANAGER
Credential:
Phone: 860-570-2140