Healthcare Provider Details

I. General information

NPI: 1669406047
Provider Name (Legal Business Name): HOLY SPIRIT RESIDENTIAL CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 CHURCH ST
PUTNAM CT
06260-1810
US

IV. Provider business mailing address

72 CHURCH ST
PUTNAM CT
06260-1810
US

V. Phone/Fax

Practice location:
  • Phone: 860-928-0891
  • Fax: 860-928-1312
Mailing address:
  • Phone: 860-928-0891
  • Fax: 860-928-1312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateCT

VIII. Authorized Official

Name: MRS. ANNEMARIE SHIROKA
Title or Position: ADMINISTRATOR
Credential:
Phone: 860-928-0891