Provider Demographics
NPI:1124186523
Name:CHELSEA PLACE CARE CENTER LLC
Entity Type:Organization
Organization Name:CHELSEA PLACE CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-570-2140
Mailing Address - Street 1:25 LORRAINE ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2242
Mailing Address - Country:US
Mailing Address - Phone:860-233-8241
Mailing Address - Fax:860-236-0309
Practice Address - Street 1:25 LORRAINE ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2242
Practice Address - Country:US
Practice Address - Phone:860-233-8241
Practice Address - Fax:860-236-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2220-C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT739OtherBC/BS
CT500009761Medicaid
075299Medicare Oscar/Certification