Healthcare Provider Details

I. General information

NPI: 1003259409
Provider Name (Legal Business Name): SOUTHINGTON SNF, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 SUMMIT ST
PLANTSVILLE CT
06479-1124
US

IV. Provider business mailing address

261 SUMMIT ST
PLANTSVILLE CT
06479-1124
US

V. Phone/Fax

Practice location:
  • Phone: 860-628-0364
  • Fax: 860-628-9166
Mailing address:
  • Phone: 860-628-0364
  • Fax: 860-628-9166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2262C
License Number StateCT

VIII. Authorized Official

Name: MICHAEL MOSIER
Title or Position: CFO
Credential:
Phone: 860-751-3900