Healthcare Provider Details

I. General information

NPI: 1861437824
Provider Name (Legal Business Name): SHORELINE LIFECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 NOTCH HILL RD
NORTH BRANFORD CT
06471-1846
US

IV. Provider business mailing address

88 NOTCH HILL RD
NORTH BRANFORD CT
06471-1846
US

V. Phone/Fax

Practice location:
  • Phone: 203-488-8000
  • Fax: 203-488-9429
Mailing address:
  • Phone: 203-488-8000
  • Fax: 203-488-9429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2189-C
License Number StateCT

VIII. Authorized Official

Name: MRS. KRSTIN BUTLER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 203-488-8000