Provider Demographics
NPI:1497960934
Name:UNITED COMMUNITY & FAMILY SERVICES
Entity Type:Organization
Organization Name:UNITED COMMUNITY & FAMILY SERVICES
Other - Org Name:SHORELINE ADULT DAY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-889-2375
Mailing Address - Street 1:1 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1227
Mailing Address - Country:US
Mailing Address - Phone:860-442-5873
Mailing Address - Fax:860-440-3301
Practice Address - Street 1:1 BEECHWOOD DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1227
Practice Address - Country:US
Practice Address - Phone:860-442-5873
Practice Address - Fax:860-440-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003UWNS337OtherCCCI VENDOR NUMBER