Provider Demographics
NPI:1932103694
Name:SAYBROOK HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:SAYBROOK HEALTH CARE CENTER, INC.
Other - Org Name:SAYBROOK CONVALESCENT HOSPITAL, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO, APPLE HEALTH CARE
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAMBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-678-9755
Mailing Address - Street 1:1775 BOSTON POST RD.
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1643
Mailing Address - Country:US
Mailing Address - Phone:860-399-6216
Mailing Address - Fax:860-399-4053
Practice Address - Street 1:1775 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1643
Practice Address - Country:US
Practice Address - Phone:860-399-6216
Practice Address - Fax:860-399-4053
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPLE HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-10
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT725-C314000000X
CT0725-CC314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT7252Medicaid
CT000007252Medicaid
CT000007252Medicaid
CT07-5070Medicare UPIN