Provider Demographics
NPI:1235545393
Name:SOUTHINGTON CARE CENTER
Entity Type:Organization
Organization Name:SOUTHINGTON CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPOATIONAL THERAPY ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:JOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:860-378-1234
Mailing Address - Street 1:19 THISTLE LN
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-8056
Mailing Address - Country:US
Mailing Address - Phone:860-584-8637
Mailing Address - Fax:
Practice Address - Street 1:45 MERIDEN AVE
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3214
Practice Address - Country:US
Practice Address - Phone:860-378-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000767314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility