Provider Demographics
NPI:1003259409
Name:SOUTHINGTON SNF, LLC.
Entity Type:Organization
Organization Name:SOUTHINGTON SNF, LLC.
Other - Org Name:THE SUMMIT AT PLANTSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-751-3900
Mailing Address - Street 1:261 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1124
Mailing Address - Country:US
Mailing Address - Phone:860-628-0364
Mailing Address - Fax:860-628-9166
Practice Address - Street 1:261 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1124
Practice Address - Country:US
Practice Address - Phone:860-628-0364
Practice Address - Fax:860-628-9166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENA HEALTH CARE ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2262C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000009464Medicaid
CT075420Medicare Oscar/Certification