Provider Demographics
NPI:1578101796
Name:GOVERNORS HOUSE SIMSBURY OPCO LLC
Entity Type:Organization
Organization Name:GOVERNORS HOUSE SIMSBURY OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SODDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-541-3277
Mailing Address - Street 1:225 PITKIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3223
Mailing Address - Country:US
Mailing Address - Phone:860-610-9009
Mailing Address - Fax:
Practice Address - Street 1:36 FIRETOWN RD
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-3401
Practice Address - Country:US
Practice Address - Phone:860-658-1018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility