Provider Demographics
NPI:1164657458
Name:PARADIGM HEALTHCARE CENTER OF WATERBURY, LLC
Entity Type:Organization
Organization Name:PARADIGM HEALTHCARE CENTER OF WATERBURY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZISKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-729-6268
Mailing Address - Street 1:177 WHITEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-1545
Mailing Address - Country:US
Mailing Address - Phone:203-757-9491
Mailing Address - Fax:203-575-1714
Practice Address - Street 1:177 WHITEWOOD RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-1545
Practice Address - Country:US
Practice Address - Phone:203-757-9491
Practice Address - Fax:203-575-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT075219OtherMEDICARE BY ASSIGNMENT
CTPENDINGMedicaid