Provider Demographics
NPI:1285628594
Name:CHURCH HOMES, INC. CONGREGATIONAL
Entity Type:Organization
Organization Name:CHURCH HOMES, INC. CONGREGATIONAL
Other - Org Name:AVERY HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:GILLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-527-9126
Mailing Address - Street 1:217 AVERY HTS
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-4271
Mailing Address - Country:US
Mailing Address - Phone:860-527-9126
Mailing Address - Fax:860-525-8977
Practice Address - Street 1:705 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-4039
Practice Address - Country:US
Practice Address - Phone:860-527-9126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHURCH HOMES, INC. CONGREGATIONAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-01
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT79RH313M00000X
CT750-C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT7500Medicaid
CT90795Medicaid
CT90795Medicaid