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General NPI Number Information
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NPI Number | 1831348226
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Entity Type | Organization
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Legal Business Name | THE HEARTH AT GARDENSIDE
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 173 ALPS RD
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City | BRANFORD
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State | CT
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Zip | 06405-4742
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Country | US
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Telephone | 203-483-7260
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Fax | 203-483-7752
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Provider Business Mailing Address
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Address Line | 173 ALPS RD
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City | BRANFORD
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State | CT
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Zip | 06405-4742
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Country | US
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Telephone | 203-483-7260
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Fax | 203-483-7752
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Authorized Official
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Title or Position | SALSA
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Name | SHARON B TRACEY
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Credential | RN
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Telephone | 203-483-7260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 0072
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License Number State | CT
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