Provider Demographics
NPI:1376777698
Name:PARADIGM HEALTHCARE CENTER OF NEW HAVEN, LLC
Entity type:Organization
Organization Name:PARADIGM HEALTHCARE CENTER OF NEW HAVEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGGAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-726-7449
Mailing Address - Street 1:181 CLIFTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-3319
Mailing Address - Country:US
Mailing Address - Phone:203-467-1666
Mailing Address - Fax:203-468-3049
Practice Address - Street 1:181 CLIFTON ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-3319
Practice Address - Country:US
Practice Address - Phone:203-467-1666
Practice Address - Fax:203-468-3049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2351314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT07-5398OtherMEDICARE BY ASSIGNMENT
CT000008177Medicaid