Provider Demographics
NPI:1619189941
Name:THE JEWISH HOME FOR THE ELDERLY OF FAIRFIELD COUNTY INC
Entity Type:Organization
Organization Name:THE JEWISH HOME FOR THE ELDERLY OF FAIRFIELD COUNTY INC
Other - Org Name:GRASMERE ON PARK ADULT DAY PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:EVANGELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-396-6455
Mailing Address - Street 1:4200 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-1049
Mailing Address - Country:US
Mailing Address - Phone:203-365-6455
Mailing Address - Fax:203-396-1108
Practice Address - Street 1:4200 PARK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-1049
Practice Address - Country:US
Practice Address - Phone:203-365-6455
Practice Address - Fax:203-396-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008044725OtherCHCPE