Provider Demographics
NPI:1366445629
Name:CSC ENTERPRISES, INC.
Entity Type:Organization
Organization Name:CSC ENTERPRISES, INC.
Other - Org Name:BRANFORD HILLS HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:203-481-6221
Mailing Address - Street 1:189 ALPS RD
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-4771
Mailing Address - Country:US
Mailing Address - Phone:203-481-6221
Mailing Address - Fax:203-483-1893
Practice Address - Street 1:189 ALPS RD
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-4771
Practice Address - Country:US
Practice Address - Phone:203-481-6221
Practice Address - Fax:203-483-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT997C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT997CMedicaid
CT075296Medicare ID - Type Unspecified
CT0282630001Medicare NSC