Provider Demographics
NPI:1326292590
Name:SHADY OAKS ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:SHADY OAKS ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:BELANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-583-1526
Mailing Address - Street 1:344 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-2769
Mailing Address - Country:US
Mailing Address - Phone:860-583-1526
Mailing Address - Fax:860-583-1297
Practice Address - Street 1:344 STEVENS ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-2769
Practice Address - Country:US
Practice Address - Phone:860-583-1526
Practice Address - Fax:860-583-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service