Healthcare Provider Details

I. General information

NPI: 1144203720
Provider Name (Legal Business Name): ESSEX MEADOWS PROPERTIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BOKUM RD
ESSEX CT
06426
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 TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2042-C
License Number StateCT

VIII. Authorized Official

Name: MRS. LISA GRIEVE
Title or Position: VP/SECRETARY/TREASURER
Credential: CPA
Phone: 515-875-4754