Healthcare Provider Details

I. General information

NPI: 1972720076
Provider Name (Legal Business Name): MULBERRY GARDENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 MULBERRY ST
PLANTSVILLE CT
06479-1704
US

IV. Provider business mailing address

58 MULBERRY ST
PLANTSVILLE CT
06479-1704
US

V. Phone/Fax

Practice location:
  • Phone: 860-276-1020
  • Fax: 860-378-1081
Mailing address:
  • Phone: 860-276-1020
  • Fax: 860-378-1081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL-0035
License Number StateCT

VIII. Authorized Official

Name: MRS. JACQUELYN GAULIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 860-276-1020