Healthcare Provider Details

I. General information

NPI: 1033173448
Provider Name (Legal Business Name): MAEFAIR HEALTH CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MAEFAIR CT
TRUMBULL CT
06611-4871
US

IV. Provider business mailing address

21 MAEFAIR CT
TRUMBULL CT
06611-4871
US

V. Phone/Fax

Practice location:
  • Phone: 203-459-5152
  • Fax: 203-459-5156
Mailing address:
  • Phone: 203-459-5152
  • Fax: 203-459-5156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2142-C
License Number StateCT

VIII. Authorized Official

Name: LAWRENCE G. SANTILLI
Title or Position: PRESIDENT/CEO
Credential:
Phone: 860-751-3900