Healthcare Provider Details

I. General information

NPI: 1366899809
Provider Name (Legal Business Name): FAMILY ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2016
Last Update Date: 05/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445A WILLARD AVE
NEWINGTON CT
06111-2318
US

IV. Provider business mailing address

445A WILLARD AVE
NEWINGTON CT
06111-2318
US

V. Phone/Fax

Practice location:
  • Phone: 860-436-2013
  • Fax:
Mailing address:
  • Phone: 860-436-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. DALE MARIE HUME
Title or Position: DIRECTOR
Credential: RN/RDH
Phone: 860-436-2013