Provider Demographics
NPI:1902843279
Name:MARATHON HEALTHCARE OF WEST HAVEN
Entity Type:Organization
Organization Name:MARATHON HEALTHCARE OF WEST HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CZERNIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-290-7514
Mailing Address - Street 1:99 E RIVER DR
Mailing Address - Street 2:RIVERVIEW SQUARE 8TH FLOOR
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3288
Mailing Address - Country:US
Mailing Address - Phone:860-528-0007
Mailing Address - Fax:860-528-5711
Practice Address - Street 1:310 TERRACE AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2638
Practice Address - Country:US
Practice Address - Phone:203-932-2247
Practice Address - Fax:203-931-2869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT075201BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER