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General NPI Number Information
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NPI Number | 1972633436
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Entity Type | Organization
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Legal Business Name | THE MARY WADE HOME, INCORPORATED
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/27/2020
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Provider Practice Location Address
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Address Line | 118 CLINTON AVE
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City | NEW HAVEN
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State | CT
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Zip | 06513-3100
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Country | US
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Telephone | 203-562-7222
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Fax | 203-848-6386
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Provider Business Mailing Address
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Address Line | 118 CLINTON AVE
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City | NEW HAVEN
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State | CT
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Zip | 06513-3100
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Country | US
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Telephone | 203-562-7222
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Fax | 203-848-6386
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Authorized Official
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Title or Position | CFO
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Name | WILLIAM CHARLES GINTER
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Credential |
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Telephone | 203-672-7817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 1665-RCH
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2051-C
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License Number State | CT
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