=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356409767
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARMINGTON CARE CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 05/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 SCOTT SWAMP RD
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06032-2825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-677-7707
-----------------------------------------------------
Fax | 860-676-0778
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 SCOTT SWAMP RD
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06032-2825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-677-7707
-----------------------------------------------------
Fax | 860-676-0778
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. CHRISTOPHER S WRIGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-570-2140
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 2288
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------