=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679400170
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMPBELL MED LTC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2026
-----------------------------------------------------
Last Update Date | 05/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 755 CAMPBELL AVE STE 1
-----------------------------------------------------
City | WEST HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06516-3789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-937-1100
-----------------------------------------------------
Fax | 203-937-1102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 755 CAMPBELL AVE STE 1
-----------------------------------------------------
City | WEST HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06516-3789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-937-1100
-----------------------------------------------------
Fax | 203-937-1102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | ROXANN AMES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-937-1100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Clinical Nurse Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------