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General NPI Number Information
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NPI Number | 1578536959
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Entity Type | Organization
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Legal Business Name | TI - WATERBURY LLC
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 2817 N MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06704-1604
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Country | US
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Telephone | 203-757-0731
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Fax | 203-596-0892
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Provider Business Mailing Address
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Address Line | 2817 N MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06704-1604
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Country | US
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Telephone | 203-757-0731
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Fax | 203-596-0892
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Authorized Official
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Title or Position | OPERATOR
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Name | JOSEPH C TUTERA
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Credential |
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Telephone | 816-444-0900
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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 | 2272
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License Number State | CT
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