Healthcare Provider Details

I. General information

NPI: 1285628594
Provider Name (Legal Business Name): CHURCH HOMES, INC. CONGREGATIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 NEW BRITAIN AVE
HARTFORD CT
06106-4039
US

IV. Provider business mailing address

217 AVERY HTS
HARTFORD CT
06106-4271
US

V. Phone/Fax

Practice location:
  • Phone: 860-527-9126
  • Fax:
Mailing address:
  • Phone: 860-527-9126
  • Fax: 860-525-8977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number79RH
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number750-C
License Number StateCT

VIII. Authorized Official

Name: MR. PATRICK J GILLAND
Title or Position: PRESIDENT/CEO
Credential:
Phone: 860-527-9126