Healthcare Provider Details

I. General information

NPI: 1508860008
Provider Name (Legal Business Name): JEROME HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 CORBIN AVE
NEW BRITAIN CT
06052-1243
US

IV. Provider business mailing address

975 CORBIN AVE
NEW BRITAIN CT
06052-1243
US

V. Phone/Fax

Practice location:
  • Phone: 860-229-3707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number2065-C
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2065-C
License Number StateCT

VIII. Authorized Official

Name: LISA CONNOLLY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 860-229-3707