Provider Demographics
NPI:1477518074
Name:CONTINUING CARE RETIREMENT COMMUNITY OF GREAT
Entity Type:Organization
Organization Name:CONTINUING CARE RETIREMENT COMMUNITY OF GREAT
Other - Org Name:EDGEHILL RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT/CHIEF OPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SILARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-275-7505
Mailing Address - Street 1:122 PALMERS HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2134
Mailing Address - Country:US
Mailing Address - Phone:203-323-2323
Mailing Address - Fax:203-323-6437
Practice Address - Street 1:122 PALMERS HILL ROAD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2134
Practice Address - Country:US
Practice Address - Phone:203-323-2323
Practice Address - Fax:203-322-6437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2226-C314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT075421Medicare UPIN