Provider Demographics
NPI:1093712325
Name:CAROLTON CHRONIC & CONVALESCENT HOSP INC
Entity Type:Organization
Organization Name:CAROLTON CHRONIC & CONVALESCENT HOSP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KRETZMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-255-3573
Mailing Address - Street 1:400 MILL PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5048
Mailing Address - Country:US
Mailing Address - Phone:203-255-3573
Mailing Address - Fax:203-254-1595
Practice Address - Street 1:400 MILL PLAIN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5048
Practice Address - Country:US
Practice Address - Phone:203-255-3573
Practice Address - Fax:203-254-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT606-C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000006064Medicaid
CT000006064Medicaid