Provider Demographics
NPI:1497961825
Name:SAINT MARY HOME -ADULT DAY CARE
Entity Type:Organization
Organization Name:SAINT MARY HOME -ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REIMBURSEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LATOVICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-343-6628
Mailing Address - Street 1:2021 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2755
Mailing Address - Country:US
Mailing Address - Phone:860-570-8285
Mailing Address - Fax:
Practice Address - Street 1:2021 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2755
Practice Address - Country:US
Practice Address - Phone:860-570-8285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000000261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004SMHS439OtherCCCI