Healthcare Provider Details

I. General information

NPI: 1629005079
Provider Name (Legal Business Name): HARBORSIDE CONNECTICUT LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 MIX AVE
HAMDEN CT
06514-2102
US

IV. Provider business mailing address

101 SUN AVE NE COMPLIANCE DEPARTMENT
ALBUQUERQUE NM
87109-4373
US

V. Phone/Fax

Practice location:
  • Phone: 203-281-3500
  • Fax:
Mailing address:
  • Phone: 505-468-5604
  • Fax: 505-468-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2199-C
License Number StateCT

VIII. Authorized Official

Name: MICHAEL THEODORE BERG
Title or Position: SECRETARY
Credential:
Phone: 505-468-4752