Provider Demographics
NPI:1790839421
Name:STATE OF CT.- OFFICE OF THE COMPTROLLER
Entity Type:Organization
Organization Name:STATE OF CT.- OFFICE OF THE COMPTROLLER
Other - Org Name:SOUTH REGION-RAINBOW HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRESCENTINO
Authorized Official - Middle Name:
Authorized Official - Last Name:SECCHIAROLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-418-8712
Mailing Address - Street 1:240 ORAL SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1208
Mailing Address - Country:US
Mailing Address - Phone:860-859-5404
Mailing Address - Fax:
Practice Address - Street 1:240 ORAL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1208
Practice Address - Country:US
Practice Address - Phone:860-859-5404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006732037Medicaid