Provider Demographics
NPI:1437167707
Name:CONNECTICUT ELDER CARE LLC
Entity Type:Organization
Organization Name:CONNECTICUT ELDER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:FNP APRN
Authorized Official - Phone:845-868-7366
Mailing Address - Street 1:6532 ROUTE 82
Mailing Address - Street 2:
Mailing Address - City:STANFORDVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12581-5702
Mailing Address - Country:US
Mailing Address - Phone:845-868-7366
Mailing Address - Fax:
Practice Address - Street 1:99 S CANAAN RD
Practice Address - Street 2:GEER NURSING AND REHAB CENTER
Practice Address - City:CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06018-2502
Practice Address - Country:US
Practice Address - Phone:860-824-5137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002806363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
50001031Medicare ID - Type Unspecified