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General NPI Number Information
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NPI Number | 1578784658
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Entity Type | Organization
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Legal Business Name | SIMONETTI REALTY INC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 101 MARSHALL LN
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City | DERBY
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State | CT
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Zip | 06418-2347
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Country | US
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Telephone | 203-734-3393
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Fax | 203-734-2100
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Provider Business Mailing Address
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Address Line | 101 MARSHALL LN
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City | DERBY
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State | CT
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Zip | 06418-2347
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Country | US
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Telephone | 203-734-3393
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Fax | 203-734-2100
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PATRICIA ANN MCCALLUM
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Credential |
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Telephone | 203-734-3393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 102RH
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License Number State | CT
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