Healthcare Provider Details

I. General information

NPI: 1427824671
Provider Name (Legal Business Name): ESSEX MEADOWS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BOKUM RD
ESSEX CT
06426-1510
US

IV. Provider business mailing address

30 BOKUM RD
ESSEX CT
06426-1510
US

V. Phone/Fax

Practice location:
  • Phone: 860-767-7201
  • Fax: 860-767-0014
Mailing address:
  • Phone: 860-767-7201
  • Fax: 860-767-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON C. VICTOR
Title or Position: SR. VP AND TREASURER
Credential:
Phone: 515-875-4619