Healthcare Provider Details

I. General information

NPI: 1629076542
Provider Name (Legal Business Name): 162 SOUTH BRITAIN ROAD OPERATING COMPANY II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 SOUTH BRITAIN ROAD
SOUTHBURY CT
06488
US

IV. Provider business mailing address

162 SOUTH BRITAIN ROAD
SOUTHBURY CT
06488
US

V. Phone/Fax

Practice location:
  • Phone: 203-264-9600
  • Fax: 203-264-9603
Mailing address:
  • Phone: 203-264-9600
  • Fax: 203-264-9603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2280
License Number StateCT

VIII. Authorized Official

Name: EMILY VAZQUEZ
Title or Position: VP, SPECIAL PROJECTS
Credential:
Phone: 978-930-6051