Provider Demographics
NPI:1669406047
Name:HOLY SPIRIT RESIDENTIAL CARE HOME
Entity type:Organization
Organization Name:HOLY SPIRIT RESIDENTIAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIROKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-928-0891
Mailing Address - Street 1:72 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1810
Mailing Address - Country:US
Mailing Address - Phone:860-928-0891
Mailing Address - Fax:860-928-1312
Practice Address - Street 1:72 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1810
Practice Address - Country:US
Practice Address - Phone:860-928-0891
Practice Address - Fax:860-928-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home