Provider Demographics
NPI:1376745240
Name:WHOLE LIFE INC.
Entity Type:Organization
Organization Name:WHOLE LIFE INC.
Other - Org Name:TRI-COUNTY ARC, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SZUBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-886-6900
Mailing Address - Street 1:216 BROAD ST FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-5335
Mailing Address - Country:US
Mailing Address - Phone:860-886-6900
Mailing Address - Fax:860-574-9223
Practice Address - Street 1:139 HIGH ST
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-3338
Practice Address - Country:US
Practice Address - Phone:860-742-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR149315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities