Healthcare Provider Details

I. General information

NPI: 1437175932
Provider Name (Legal Business Name): LEDGECREST HEALTH CARE CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 KENSINGTON RD
KENSINGTON CT
06037-2602
US

IV. Provider business mailing address

154 KENSINGTON RD
KENSINGTON CT
06037-2602
US

V. Phone/Fax

Practice location:
  • Phone: 860-828-0583
  • Fax: 860-828-4946
Mailing address:
  • Phone: 860-828-0583
  • Fax: 860-828-4946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2046C
License Number StateCT

VIII. Authorized Official

Name: MR. RYAN VESS
Title or Position: CFO
Credential:
Phone: 860-678-9755