Healthcare Provider Details

I. General information

NPI: 1093714016
Provider Name (Legal Business Name): LORD CHAMBERLAIN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7003 MAIN ST
STRATFORD CT
06614-1393
US

IV. Provider business mailing address

7003 MAIN ST
STRATFORD CT
06614-1393
US

V. Phone/Fax

Practice location:
  • Phone: 203-375-5894
  • Fax: 203-375-1199
Mailing address:
  • Phone: 203-375-5894
  • Fax: 203-375-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number968-C
License Number StateCT

VIII. Authorized Official

Name: DR. ROBERT SBRIGLIO
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 203-375-5894