Healthcare Provider Details

I. General information

NPI: 1720421407
Provider Name (Legal Business Name): ABBOTT TERRACE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 ABBOTT TER
WATERBURY CT
06702-1431
US

IV. Provider business mailing address

44 ABBOTT TER
WATERBURY CT
06702-1431
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 Code314000000X
TaxonomySkilled Nursing Facility
License Number1089C
License Number StateCT

VIII. Authorized Official

Name: MICHAEL MOSIER
Title or Position: CFO
Credential:
Phone: 860-751-3900