Healthcare Provider Details

I. General information

NPI: 1093822843
Provider Name (Legal Business Name): MATULAITIS NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 THURBER RD
PUTNAM CT
06260-2518
US

IV. Provider business mailing address

10 THURBER RD
PUTNAM CT
06260-2518
US

V. Phone/Fax

Practice location:
  • Phone: 860-928-7976
  • Fax:
Mailing address:
  • Phone: 860-928-7976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0989
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number5784720001
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number5784720001
License Number StateCT

VIII. Authorized Official

Name: BETH J GREGOIRE
Title or Position: PATIENT ACCOUNTS
Credential:
Phone: 860-928-7976