Healthcare Provider Details

I. General information

NPI: 1497961825
Provider Name (Legal Business Name): SAINT MARY HOME -ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 ALBANY AVE
WEST HARTFORD CT
06117-2755
US

IV. Provider business mailing address

2021 ALBANY AVE
WEST HARTFORD CT
06117-2755
US

V. Phone/Fax

Practice location:
  • Phone: 860-570-8285
  • Fax:
Mailing address:
  • Phone: 860-570-8285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number000000
License Number StateCT

VIII. Authorized Official

Name: MS. PAMELA SUE LATOVICK
Title or Position: VP OF REIMBURSEMENT
Credential:
Phone: 734-343-6628