Healthcare Provider Details

I. General information

NPI: 1205873742
Provider Name (Legal Business Name): GLADEVIEW HEALTH CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 BOSTON POST RD
OLD SAYBROOK CT
06475
US

IV. Provider business mailing address

60 BOSTON POST RD
OLD SAYBROOK CT
06475-1503
US

V. Phone/Fax

Practice location:
  • Phone: 860-388-6696
  • Fax: 860-395-0093
Mailing address:
  • Phone: 860-388-6696
  • Fax: 860-395-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2024-C
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000020248
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer

VIII. Authorized Official

Name: MRS. STACY M. LACASSE
Title or Position: ADMINISTRATOR
Credential:
Phone: 860-388-6696