Healthcare Provider Details

I. General information

NPI: 1710024484
Provider Name (Legal Business Name): ABBOT TERRACE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 ABBOTT TERRACE
WATERBURY CT
06702
US

IV. Provider business mailing address

44 ABBOTT TERRACE
WATERBURY CT
06702
US

V. Phone/Fax

Practice location:
  • Phone: 203-755-4870
  • Fax: 203-755-9016
Mailing address:
  • Phone: 203-755-4870
  • Fax: 203-755-9016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. LAWRENCE M CLARK
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 203-755-4870