Provider Demographics
NPI:1700895729
Name:EASTERN CONNECTICUT REHABILI
Entity Type:Organization
Organization Name:EASTERN CONNECTICUT REHABILI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:REMI
Authorized Official - Last Name:MAILHOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-889-1948
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:DAYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06241-0425
Mailing Address - Country:US
Mailing Address - Phone:860-889-1948
Mailing Address - Fax:860-889-1101
Practice Address - Street 1:1666 ROUTE 12
Practice Address - Street 2:
Practice Address - City:GALES FERRY
Practice Address - State:CT
Practice Address - Zip Code:06335
Practice Address - Country:US
Practice Address - Phone:860-889-1948
Practice Address - Fax:860-537-5926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT14104OtherORTHNET CIGNA
CTA2752221OtherOXFORD
CTOV7727OtherHEALTHNET
CTA2752221OtherOXFORD
CTA2752221OtherOXFORD