Provider Demographics
NPI:1942604392
Name:JACC HEALTHCARE CENTER OF WINDHAM, LLC
Entity Type:Organization
Organization Name:JACC HEALTHCARE CENTER OF WINDHAM, LLC
Other - Org Name:VANDERMAN PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZISKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-450-7060
Mailing Address - Street 1:595 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-1901
Mailing Address - Country:US
Mailing Address - Phone:860-450-7060
Mailing Address - Fax:860-450-7070
Practice Address - Street 1:595 VALLEY ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-1901
Practice Address - Country:US
Practice Address - Phone:860-450-7060
Practice Address - Fax:860-450-7070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACC HEALTHCARE GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-14
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility