Healthcare Provider Details

I. General information

NPI: 1528285152
Provider Name (Legal Business Name): CAROL LEE LAFAUCI COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 LONG HILL RD
MIDDLETOWN CT
06457-4063
US

IV. Provider business mailing address

53 BRONSON RD POB 7145
PROSPECT CT
06712-1000
US

V. Phone/Fax

Practice location:
  • Phone: 866-552-9292
  • Fax:
Mailing address:
  • Phone: 203-758-0230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000570
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: