Provider Demographics
NPI:1033355664
Name:COLONIAL CARE OF NORWICH LLC
Entity Type:Organization
Organization Name:COLONIAL CARE OF NORWICH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-556-9177
Mailing Address - Street 1:60 CROUCH AVE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-7329
Mailing Address - Country:US
Mailing Address - Phone:860-889-2631
Mailing Address - Fax:
Practice Address - Street 1:60 CROUCH AVE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-7329
Practice Address - Country:US
Practice Address - Phone:860-889-2631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLONIAL CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-03
Last Update Date:2009-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00002275314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT075417Medicare PIN