Provider Demographics
NPI:1063845865
Name:SOUTHINGTON CARE CENTER
Entity Type:Organization
Organization Name:SOUTHINGTON CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:860-951-2725
Mailing Address - Street 1:2 PARK PL
Mailing Address - Street 2:APT 14C
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5007
Mailing Address - Country:US
Mailing Address - Phone:860-951-2725
Mailing Address - Fax:
Practice Address - Street 1:2 PARK PL
Practice Address - Street 2:APT 14C
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5007
Practice Address - Country:US
Practice Address - Phone:860-951-2725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility