Healthcare Provider Details

I. General information

NPI: 1457554859
Provider Name (Legal Business Name): MANSFIELD RETIREMENT COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SILO CIRCLE
STORRS CT
06268-2018
US

IV. Provider business mailing address

1 SILO CIRCLE
STORRS CT
06268-2018
US

V. Phone/Fax

Practice location:
  • Phone: 860-429-9933
  • Fax: 860-429-6104
Mailing address:
  • Phone: 860-429-9933
  • Fax: 860-429-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number1322
License Number StateCT

VIII. Authorized Official

Name: MRS. MARCIA ELIZABETH ZIMMER
Title or Position: ADMINISTRATOR
Credential:
Phone: 860-429-9933