Provider Demographics
NPI:1972720076
Name:MULBERRY GARDENS
Entity Type:Organization
Organization Name:MULBERRY GARDENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAULIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-276-1020
Mailing Address - Street 1:58 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1704
Mailing Address - Country:US
Mailing Address - Phone:860-276-1020
Mailing Address - Fax:860-378-1081
Practice Address - Street 1:58 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1704
Practice Address - Country:US
Practice Address - Phone:860-276-1020
Practice Address - Fax:860-378-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
CTAL-0035310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care