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General NPI Number Information
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NPI Number | 1851414585
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Entity Type | Organization
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Legal Business Name | LUTHER RIDGE AT MIDDLETOWN, INC
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 628 CONGDON ST W
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City | MIDDLETOWN
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State | CT
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Zip | 06457-7939
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Country | US
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Telephone | 860-347-7144
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Fax | 860-347-3942
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Provider Business Mailing Address
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Address Line | 628 CONGDON ST W
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City | MIDDLETOWN
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State | CT
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Zip | 06457-7939
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SUSAN SOKOL
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Credential |
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Telephone | 860-347-7144
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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 | 0113
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License Number State | CT
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