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General NPI Number Information
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NPI Number | 1568773455
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Entity Type | Organization
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Legal Business Name | PREMIER CARE OF WOODBURY
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Dates
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Enumeration Date | 06/25/2010
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 280 MIDDLE ROAD TPKE
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City | WOODBURY
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State | CT
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Zip | 06798-3002
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Country | US
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Telephone | 203-263-2009
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Fax |
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Provider Business Mailing Address
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Address Line | 280 MIDDLE ROAD TPKE
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City | WOODBURY
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State | CT
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Zip | 06798-3002
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Country | US
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Telephone | 203-263-2009
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEVANSHI AMIN
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Credential |
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Telephone | 203-263-2009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 1883
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License Number State | CT
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