Provider Demographics
NPI:1083613798
Name:FRANCISCAN FAMILY CARE CENTER, INC.
Entity Type:Organization
Organization Name:FRANCISCAN FAMILY CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SISTER SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:FSE
Authorized Official - Phone:203-238-1441
Mailing Address - Street 1:267 FINCH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2715
Mailing Address - Country:US
Mailing Address - Phone:203-238-1441
Mailing Address - Fax:203-686-0807
Practice Address - Street 1:267 FINCH AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2715
Practice Address - Country:US
Practice Address - Phone:203-238-1441
Practice Address - Fax:203-686-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC87714251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004071577Medicaid
CT077173Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CT004071577Medicaid