Provider Demographics
NPI:1336196773
Name:MARATHON HEALTHCARE OF TORRINGTON
Entity Type:Organization
Organization Name:MARATHON HEALTHCARE OF TORRINGTON
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 1:80 FERN DR
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3807
Mailing Address - Country:US
Mailing Address - Phone:860-482-7668
Mailing Address - Fax:860-482-3963
Practice Address - Street 1:99 E RIVER DR
Practice Address - Street 2:RIVERVIEW SQUARE 8THFLOOR
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3288
Practice Address - Country:US
Practice Address - Phone:860-520-0007
Practice Address - Fax:860-528-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2301314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT900009621Medicaid
CT900009621Medicaid