Provider Demographics
NPI:1851900609
Name:SOUTHBURY HEALTH GROUP LLC
Entity Type:Organization
Organization Name:SOUTHBURY HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOZADJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-636-0005
Mailing Address - Street 1:990 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-1267
Mailing Address - Country:US
Mailing Address - Phone:203-264-9135
Mailing Address - Fax:203-262-6714
Practice Address - Street 1:990 MAIN ST N
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-1267
Practice Address - Country:US
Practice Address - Phone:203-264-9135
Practice Address - Fax:203-262-6714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility