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General NPI Number Information
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NPI Number | 1083607543
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Entity Type | Organization
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Legal Business Name | BROOK HOLLOW HEALTH CARE CENTER LLC
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 05/20/2011
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Provider Practice Location Address
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Address Line | 55 KONDRACKI LANE
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City | WALLINGFORD
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State | CT
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Zip | 06492-4951
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Country | US
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Telephone | 203-265-6771
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Fax | 203-284-3883
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Provider Business Mailing Address
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Address Line | 538 PRESTON AVE SUITE 270
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City | MERIDEN
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State | CT
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Zip | 06450-4851
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Country | US
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Telephone | 203-608-6100
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Fax | 203-639-3574
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Authorized Official
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Title or Position | LLC MANAGER
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Name | MS. CAROLE M. SCILLIA
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Credential |
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Telephone | 203-608-6100
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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 | 2223-C
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License Number State | CT
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