EASTER SEAL REHABILITATION CENTER

Provider Demographics

• NPI: 1497863658
• Name: EASTER SEAL REHABILITATION CENTER
• Entity Type: Organization
• Organization Name: EASTER SEAL REHABILITATION CENTER
• Other - Org Name: EASTER SEALS WATERBURY
• Other - Org Type: Other Name
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: MRS
• Authorized Official - First Name: LORAINE
• Authorized Official - Last Name: SHEA
• Authorized Official - Phone: 203-754-5141
• Mailing Address - Street 1: 22 TOMPKINS ST
• Mailing Address - City: WATERBURY
• Mailing Address - State: CT
• Mailing Address - Zip Code: 06708-1417
• Mailing Address - Country: US
• Mailing Address - Phone: 203-574-5141
• Mailing Address - Fax: 202-757-1198
• Practice Address - Street 1: 22 TOMPKINS ST
• Practice Address - City: WATERBURY
• Practice Address - State: CT
• Practice Address - Zip Code: 06708-1417
• Practice Address - Country: US
• Practice Address - Phone: 203-574-5141
• Practice Address - Fax: 202-757-1198
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-08-28
• Last Update Date: 2016-07-27

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261Q00000X	Ambulatory Health Care Facilities	Clinic/Center		Group - Multi-Specialty
Yes	261QR0400X	Ambulatory Health Care Facilities	Clinic/Center	Rehabilitation	Group - Multi-Specialty
No	251C00000X	Agencies	Day Training, Developmentally Disabled Services
No	261QA3000X	Ambulatory Health Care Facilities	Clinic/Center	Augmentative Communication
No	261QD1600X	Ambulatory Health Care Facilities	Clinic/Center	Developmental Disabilities
No	261QH0700X	Ambulatory Health Care Facilities	Clinic/Center	Hearing and Speech
No	261QM0850X	Ambulatory Health Care Facilities	Clinic/Center	Adult Mental Health
No	261QP2000X	Ambulatory Health Care Facilities	Clinic/Center	Physical Therapy
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CT	017500	Other	CONNECTICARE-AUDIOLOGY
CT	185832	Other	PREFERRED ONE-HUSKY
CT	246000	Other	CONNECTICARE-AUDIOLOGY
CT	68BT03016CT01	Other	BCBS-BIRTH TO THREE
CT	296184	Other	WELLCARE
CT	3561698	Other	AETNA-AUDIOLOGY
CT	800009105CT01	Other	BLUE CROSS BLUE SHIELD
CT	OR2189	Other	HEALTHNET
CT	5617574	Other	AETNA-AUDIOLOGY
CT	43MDE0003CT01	Other	BLUE CROSS BLUE SHIELD
CT	004015061	Medicaid
CT	004039657	Medicaid
CT	04154	Other	HEARUSA-AUDIOLOGY
CT	04731	Other	HEARUSA-AUDIOLOGY
CT	12DME0601CT01	Other	BCBS-DME
CT	246000	Other	CONNECTICARE-AUDIOLOGY
CT	004039657	Medicaid