Provider Demographics
NPI:1396814547
Name:MERIDEN HEALTH CARE CENTER INC
Entity Type:Organization
Organization Name:MERIDEN HEALTH CARE CENTER INC
Other - Org Name:COCCOMO MEMORIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-678-9755
Mailing Address - Street 1:33 CONE AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4822
Mailing Address - Country:US
Mailing Address - Phone:203-238-1606
Mailing Address - Fax:203-235-0299
Practice Address - Street 1:33 CONE AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-4822
Practice Address - Country:US
Practice Address - Phone:203-238-1606
Practice Address - Fax:203-235-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2074-C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000020743Medicaid
CT000020743Medicaid