Provider Demographics
NPI:1508844168
Name:MCLEAN AFFILIATES, INC.
Entity Type:Organization
Organization Name:MCLEAN AFFILIATES, INC.
Other - Org Name:MCLEAN HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TITO
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-658-3700
Mailing Address - Street 1:75 GREAT POND RD
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-1980
Mailing Address - Country:US
Mailing Address - Phone:860-658-3700
Mailing Address - Fax:860-658-1247
Practice Address - Street 1:75 GREAT POND RD
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-1980
Practice Address - Country:US
Practice Address - Phone:860-658-3700
Practice Address - Fax:860-658-1247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000008847Medicaid
CT000008847Medicaid