Healthcare Provider Details

I. General information

NPI: 1487875712
Provider Name (Legal Business Name): CHESTELM ADULT DAY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 TOWN STREET
MOODUS CT
06469
US

IV. Provider business mailing address

PO BOX 584 542 TOWN STREET
MOODUS CT
06469
US

V. Phone/Fax

Practice location:
  • Phone: 860-873-3833
  • Fax: 860-873-1091
Mailing address:
  • Phone: 860-873-3833
  • Fax: 860-873-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRENDA E MARINAN
Title or Position: DIRECTOR
Credential:
Phone: 860-873-6533