=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609837392
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAUGATUCK HEALTH CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2006
-----------------------------------------------------
Last Update Date | 02/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 89 WEID DR
-----------------------------------------------------
City | NAUGATUCK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-729-9889
-----------------------------------------------------
Fax | 203-720-4082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 89 WEID DR
-----------------------------------------------------
City | NAUGATUCK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-729-9889
-----------------------------------------------------
Fax | 203-720-4082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | LAWRENCE G SANTILLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-751-3900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 2182-C
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------