Healthcare Provider Details

I. General information

NPI: 1093808081
Provider Name (Legal Business Name): MVM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 WOODBURY RD
WATERTOWN CT
06795-1725
US

IV. Provider business mailing address

560 WOODBURY ROAD
WATERTOWN CT
06795-1725
US

V. Phone/Fax

Practice location:
  • Phone: 860-274-6748
  • Fax: 860-274-5972
Mailing address:
  • Phone: 860-274-6748
  • Fax: 860-274-5972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2063C
License Number StateCT

VIII. Authorized Official

Name: MR. MICHAEL J VINCITORIO
Title or Position: ADMINISTRATOR
Credential:
Phone: 860-274-6748