Provider Demographics
NPI:1629249487
Name:WATERMARK RETIREMENT COMMUNITIES OF CONNECTICUT
Entity Type:Organization
Organization Name:WATERMARK RETIREMENT COMMUNITIES OF CONNECTICUT
Other - Org Name:THE SPRINGS AT WATERMARK EAST HILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER OF SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRESHWATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-797-4000
Mailing Address - Street 1:2020 W RUDASILL RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7800
Mailing Address - Country:US
Mailing Address - Phone:520-797-4000
Mailing Address - Fax:520-797-7757
Practice Address - Street 1:611 E HILL RD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-1388
Practice Address - Country:US
Practice Address - Phone:203-262-6868
Practice Address - Fax:203-264-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2328314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
075441Medicare Oscar/Certification