Healthcare Provider Details

I. General information

NPI: 1982609673
Provider Name (Legal Business Name): CHESTELM HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 TOWN ST
MOODUS CT
06469-1101
US

IV. Provider business mailing address

534 TOWN ST
MOODUS CT
06469-1101
US

V. Phone/Fax

Practice location:
  • Phone: 860-873-1455
  • Fax: 860-873-2307
Mailing address:
  • Phone: 860-873-1455
  • Fax: 860-873-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2196-C
License Number StateCT

VIII. Authorized Official

Name: MRS. BRENDA MARINAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 860-873-1455