Healthcare Provider Details

I. General information

NPI: 1851900609
Provider Name (Legal Business Name): SOUTHBURY HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 MAIN ST N
SOUTHBURY CT
06488-1267
US

IV. Provider business mailing address

990 MAIN ST N
SOUTHBURY CT
06488-1267
US

V. Phone/Fax

Practice location:
  • Phone: 203-264-9135
  • Fax: 203-262-6714
Mailing address:
  • Phone: 203-264-9135
  • Fax: 203-262-6714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. BRODIE BOZADJIAN
Title or Position: PARTNER
Credential:
Phone: 857-636-0005