=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821101486
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALNUT HILL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2006
-----------------------------------------------------
Last Update Date | 12/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 GRAND STREET
-----------------------------------------------------
City | NEW BRITAIN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06052-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-223-3617
-----------------------------------------------------
Fax | 860-229-1820
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 GRAND STREET
-----------------------------------------------------
City | NEW BRITAIN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-223-3617
-----------------------------------------------------
Fax | 860-229-1820
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTRATOR
-----------------------------------------------------
Name | DONALD J. GRIGGS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-223-3617
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 1043-C
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------