Healthcare Provider Details

I. General information

NPI: 1669502365
Provider Name (Legal Business Name): SHELTON LAKES HEALTH CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LAKE RD
SHELTON CT
06484-2967
US

IV. Provider business mailing address

5 LAKE RD
SHELTON CT
06484-2967
US

V. Phone/Fax

Practice location:
  • Phone: 203-924-2635
  • Fax: 203-924-0034
Mailing address:
  • Phone: 203-924-2635
  • Fax: 203-924-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2298-C
License Number StateCT

VIII. Authorized Official

Name: MR. MARK HAMBLEY
Title or Position: CFO
Credential:
Phone: 860-678-9755