Healthcare Provider Details

I. General information

NPI: 1932103694
Provider Name (Legal Business Name): SAYBROOK HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 BOSTON POST RD
OLD SAYBROOK CT
06475-1643
US

IV. Provider business mailing address

1775 BOSTON POST RD.
OLD SAYBROOK CT
06475-1643
US

V. Phone/Fax

Practice location:
  • Phone: 860-399-6216
  • Fax: 860-399-4053
Mailing address:
  • Phone: 860-399-6216
  • Fax: 860-399-4053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number725-C
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0725-CC
License Number StateCT

VII. Legacy identifiers

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

# 1
Identifier7252
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer
# 2
Identifier000007252
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer

VIII. Authorized Official

Name: MARK E. HAMBLEY
Title or Position: CFO, APPLE HEALTH CARE
Credential:
Phone: 860-678-9755