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General NPI Number Information
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NPI Number | 1083601058
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Entity Type | Organization
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Legal Business Name | TI - CROMWELL LLC
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 09/29/2008
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Provider Practice Location Address
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Address Line | 385 MAIN ST
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City | CROMWELL
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State | CT
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Zip | 06416-2308
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Country | US
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Telephone | 860-636-5613
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Fax |
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Provider Business Mailing Address
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Address Line | 385 MAIN ST
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City | CROMWELL
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State | CT
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Zip | 06416-2308
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATOR
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Name | JOSEPH C TUTERA
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Credential |
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Telephone | 816-444-0900
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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 | 1025C
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License Number State | CT
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