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General NPI Number Information
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NPI Number | 1205979457
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Entity Type | Organization
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Legal Business Name | COOK WILLOW CONVALESCENT HOSPITAL, INC.
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 81 HILLSIDE AVE
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City | PLYMOUTH
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State | CT
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Zip | 06782-2305
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Country | US
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Telephone | 860-283-8208
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Fax | 860-283-6667
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Provider Business Mailing Address
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Address Line | 81 HILLSIDE AVE
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City | PLYMOUTH
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State | CT
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Zip | 06782-2305
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Country | US
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Telephone | 860-283-8208
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Fax | 860-283-6667
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SUSAN A. MACDONALD
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Credential | R.N.
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Telephone | 860-283-8208
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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 | 932-C
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License Number State | CT
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