Healthcare Provider Details

I. General information

NPI: 1891725008
Provider Name (Legal Business Name): GARDNER HEIGHTS HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 ROCKY REST RD
SHELTON CT
06484
US

IV. Provider business mailing address

172 ROCKY REST RD
SHELTON CT
06484
US

V. Phone/Fax

Practice location:
  • Phone: 203-929-1481
  • Fax: 203-929-9468
Mailing address:
  • Phone: 203-929-1481
  • Fax: 203-929-9468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2296-C
License Number StateCT

VIII. Authorized Official

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