Provider Demographics
NPI:1053447417
Name:STATE OF CT. - OFFICE OF THE COMPTROLLER
Entity Type:Organization
Organization Name:STATE OF CT. - OFFICE OF THE COMPTROLLER
Other - Org Name:STS COTTAGE 36 LAUREL LANE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRESCENTINO
Authorized Official - Middle Name:
Authorized Official - Last Name:SECCHIAROLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-418-8712
Mailing Address - Street 1:PO BOX 872
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-0901
Mailing Address - Country:US
Mailing Address - Phone:203-586-2000
Mailing Address - Fax:203-586-2700
Practice Address - Street 1:1461 BRITAIN RD S
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-1139
Practice Address - Country:US
Practice Address - Phone:203-586-2000
Practice Address - Fax:203-586-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006782007Medicaid
CTC00793OtherMEDICARE ID - TYPE UNSPECIFIED