Healthcare Provider Details

I. General information

NPI: 1205994480
Provider Name (Legal Business Name): ORCHARD GROVE SPECIALTY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 RICHARD BROWN DRIVE
UNCASVILLE CT
06382
US

IV. Provider business mailing address

5 RICHARD BROWN DRIVE
UNCASVILLE CT
06382
US

V. Phone/Fax

Practice location:
  • Phone: 860-848-8466
  • Fax: 860-848-7456
Mailing address:
  • Phone: 860-848-8466
  • Fax: 860-848-7456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2306
License Number StateCT

VIII. Authorized Official

Name: MR. MARK HAMBLEY
Title or Position: CFO
Credential:
Phone: 860-678-9755