Provider Demographics
NPI:1497755870
Name:NEW SAMARITAN CORPORATION
Entity Type:Organization
Organization Name:NEW SAMARITAN CORPORATION
Other - Org Name:MANSFIELD CENTER FOR NURSING & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:FIDANZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-487-2300
Mailing Address - Street 1:100 WARREN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268-2074
Mailing Address - Country:US
Mailing Address - Phone:860-487-2300
Mailing Address - Fax:860-487-0022
Practice Address - Street 1:100 WARREN CIRCLE
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268
Practice Address - Country:US
Practice Address - Phone:860-487-2300
Practice Address - Fax:860-487-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
CT2132C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000021329Medicaid
CT075402Medicare ID - Type UnspecifiedPROVIDER NUMBER