Provider Demographics
NPI:1669478715
Name:CENTER FOR HOSPICE CARE SOUTHEAST CONNECTICUT, INC.
Entity Type:Organization
Organization Name:CENTER FOR HOSPICE CARE SOUTHEAST CONNECTICUT, INC.
Other - Org Name:HOSPICE OF SOUTHEASTERN CONNECTICUT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAHIER
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:860-848-5699
Mailing Address - Street 1:227 DUNHAM ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-6133
Mailing Address - Country:US
Mailing Address - Phone:860-848-5699
Mailing Address - Fax:860-848-6898
Practice Address - Street 1:227 DUNHAM ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-6133
Practice Address - Country:US
Practice Address - Phone:860-848-5699
Practice Address - Fax:860-848-6898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC-90538251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004099455Medicaid
CT07-7177Medicare ID - Type UnspecifiedHOME HEALTH