Provider Demographics
NPI:1235108200
Name:FILOSA CARE CENTER,INC.
Entity Type:Organization
Organization Name:FILOSA CARE CENTER,INC.
Other - Org Name:HANCOCK HALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:203-794-9466
Mailing Address - Street 1:31 STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5323
Mailing Address - Country:US
Mailing Address - Phone:203-794-9466
Mailing Address - Fax:203-791-2613
Practice Address - Street 1:31 STAPLES ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5323
Practice Address - Country:US
Practice Address - Phone:203-794-9466
Practice Address - Fax:203-791-2613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2158C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000021858Medicaid
CT000091942Medicaid
CT000021858Medicaid