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General NPI Number Information
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NPI Number | 1366445629
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Entity Type | Organization
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Legal Business Name | CSC ENTERPRISES, INC.
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 189 ALPS RD
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City | BRANFORD
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State | CT
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Zip | 06405-4771
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Country | US
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Telephone | 203-481-6221
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Fax | 203-483-1893
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Provider Business Mailing Address
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Address Line | 189 ALPS RD
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City | BRANFORD
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State | CT
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Zip | 06405-4771
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Country | US
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Telephone | 203-481-6221
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Fax | 203-483-1893
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. STEPHEN JONES SHELTON
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Credential | M.P.H.
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Telephone | 203-481-6221
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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 | 997C
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License Number State | CT
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