Healthcare Provider Details

I. General information

NPI: 1679031074
Provider Name (Legal Business Name): HAMDEN CT SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 SHERMAN LANE
HAMDEN CT
06514
US

IV. Provider business mailing address

135 SOUTH RD
FARMINGTON CT
06032-2556
US

V. Phone/Fax

Practice location:
  • Phone: 203-281-7555
  • Fax: 203-281-3827
Mailing address:
  • Phone: 860-751-3915
  • Fax: 860-751-3905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE G. SANTILLI
Title or Position: MANAGER
Credential:
Phone: 860-751-3900