Healthcare Provider Details

I. General information

NPI: 1649487026
Provider Name (Legal Business Name): MILL RIVER FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W BROAD ST
STAMFORD CT
06902-3633
US

IV. Provider business mailing address

146 W BROAD ST
STAMFORD CT
06902-3633
US

V. Phone/Fax

Practice location:
  • Phone: 203-964-8500
  • Fax: 203-356-9925
Mailing address:
  • Phone: 203-964-8500
  • Fax: 203-356-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2327
License Number StateCT

VIII. Authorized Official

Name: JULIE MITTLEIDER
Title or Position: PRESIDENT
Credential:
Phone: 770-619-0866