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General NPI Number Information
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NPI Number | 1821537648
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Entity Type | Organization
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Legal Business Name | RESILIENT LIVING PC
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 1261 S MAIN ST
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City | PLANTSVILLE
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State | CT
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Zip | 06479-1750
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Country | US
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Telephone | 860-628-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 1261 S MAIN ST
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City | PLANTSVILLE
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State | CT
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Zip | 06479-1750
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Country | US
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Telephone | 860-628-9000
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ANNE M KENNY
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Credential | MD
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Telephone | 860-628-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 030589
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 030589
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License Number State | CT
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