Healthcare Provider Details

I. General information

NPI: 1083607543
Provider Name (Legal Business Name): BROOK HOLLOW HEALTH CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 05/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 KONDRACKI LANE
WALLINGFORD CT
06492-4951
US

IV. Provider business mailing address

538 PRESTON AVE SUITE 270
MERIDEN CT
06450-4851
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-6771
  • Fax: 203-284-3883
Mailing address:
  • Phone: 203-608-6100
  • Fax: 203-639-3574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2223-C
License Number StateCT

VIII. Authorized Official

Name: MS. CAROLE M. SCILLIA
Title or Position: LLC MANAGER
Credential:
Phone: 203-608-6100