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General NPI Number Information
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NPI Number | 1063411080
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Entity Type | Organization
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Legal Business Name | CHAMBERLAIN HEALTH CARE INC
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 05/11/2015
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Provider Practice Location Address
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Address Line | 7003 MAIN ST
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City | STRATFORD
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State | CT
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Zip | 06614-1393
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Country | US
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Telephone | 203-375-5894
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Fax | 203-375-1199
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Provider Business Mailing Address
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Address Line | 7003 MAIN ST
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City | STRATFORD
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State | CT
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Zip | 06614-1393
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Country | US
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Telephone | 203-375-5894
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Fax | 203-375-1199
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. RICHARD BATES
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Credential |
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Telephone | 203-375-5894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2197-C
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License Number State | CT
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