Provider Demographics
NPI:1790779627
Name:SUFFIELD MANOR INC
Entity Type:Organization
Organization Name:SUFFIELD MANOR INC
Other - Org Name:THE SUFFIELD HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANFILIPPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-668-6111
Mailing Address - Street 1:ONE CANAL ROAD
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-1921
Mailing Address - Country:US
Mailing Address - Phone:860-668-6111
Mailing Address - Fax:860-668-0061
Practice Address - Street 1:1 CANAL RD
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-1921
Practice Address - Country:US
Practice Address - Phone:860-668-6111
Practice Address - Fax:860-668-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2075C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000020751Medicaid
CT000020751Medicaid