Provider Demographics
NPI:1093884926
Name:EASTER SEAL REHABILITATION CENTER
Entity Type:Organization
Organization Name:EASTER SEAL REHABILITATION CENTER
Other - Org Name:EASTER SEAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-754-5141
Mailing Address - Street 1:22 TOMPKINS ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-1417
Mailing Address - Country:US
Mailing Address - Phone:203-754-5141
Mailing Address - Fax:203-757-1198
Practice Address - Street 1:22 TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-1417
Practice Address - Country:US
Practice Address - Phone:203-754-5141
Practice Address - Fax:203-757-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332S00000XSuppliersHearing Aid Equipment
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT185832OtherPREFERRED ONE-WELLCARE
CT296184OtherPREFERRED ONE-WELLCARE
CT04731OtherHEARUSA
CT004015061Medicaid
CT12DME0601CT01OtherBCBS-DME
CTOR2189OtherHEALTH NET
CT04154OtherHEARUSA
CT04731OtherHEARUSA