Provider Demographics
NPI:1780670299
Name:EASTERN CT HEALTH SYSTEMS INC
Entity Type:Organization
Organization Name:EASTERN CT HEALTH SYSTEMS INC
Other - Org Name:FOUNTAINVIEW CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PETTEY
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:860-442-0471
Mailing Address - Street 1:88 CLARK LANE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385
Mailing Address - Country:US
Mailing Address - Phone:860-442-0471
Mailing Address - Fax:860-440-3574
Practice Address - Street 1:88 CLARK LANE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385
Practice Address - Country:US
Practice Address - Phone:860-442-0471
Practice Address - Fax:860-440-3574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1048C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
075158Medicare ID - Type Unspecified