Provider Demographics
NPI:1386029247
Name:FAIRFIELD COUNTY SENIOR SERVICES, L.L.C.
Entity Type:Organization
Organization Name:FAIRFIELD COUNTY SENIOR SERVICES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERIT
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-373-0498
Mailing Address - Street 1:P.O. BOX 429
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612
Mailing Address - Country:US
Mailing Address - Phone:203-373-0498
Mailing Address - Fax:
Practice Address - Street 1:52 MARSH RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:CT
Practice Address - Zip Code:06612
Practice Address - Country:US
Practice Address - Phone:203-373-0498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0000504372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty