Healthcare Provider Details

I. General information

NPI: 1437436169
Provider Name (Legal Business Name): MEADOWBROOK CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 SALMON BROOK ST
GRANBY CT
06035-1842
US

IV. Provider business mailing address

350 SALMON BROOK ST
GRANBY CT
06035-1842
US

V. Phone/Fax

Practice location:
  • Phone: 860-653-9888
  • Fax: 860-653-8938
Mailing address:
  • Phone: 860-653-9888
  • Fax: 860-653-8938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2080C
License Number StateCT

VIII. Authorized Official

Name: MR. DON DAVANZO
Title or Position: ADMINISTRATOR
Credential:
Phone: 860-653-9888