Provider Demographics
NPI:1710056940
Name:WATROUS NURSING CENTER INC.
Entity Type:Organization
Organization Name:WATROUS NURSING CENTER INC.
Other - Org Name:WATROUS NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, APPLE HEALTH CARE, INC
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-678-9755
Mailing Address - Street 1:9 NECK RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2819
Mailing Address - Country:US
Mailing Address - Phone:203-245-9483
Mailing Address - Fax:203-245-4668
Practice Address - Street 1:9 NECK RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2819
Practice Address - Country:US
Practice Address - Phone:203-245-9483
Practice Address - Fax:203-245-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1099-C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000010991Medicaid
CT075328Medicare Oscar/Certification