Provider Demographics
NPI:1811087224
Name:SAINT JOSEPHS LIVING CENTER INC
Entity type:Organization
Organization Name:SAINT JOSEPHS LIVING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:WILLIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-423-8439
Mailing Address - Street 1:14 CLUB ROAD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06280
Mailing Address - Country:US
Mailing Address - Phone:860-456-1107
Mailing Address - Fax:860-450-7114
Practice Address - Street 1:14 CLUB ROAD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:CT
Practice Address - Zip Code:06280
Practice Address - Country:US
Practice Address - Phone:860-456-1107
Practice Address - Fax:860-450-7114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2039C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTIV5668OtherHEALTHNET INPATIENT
CTOV1833OtherHEALTHNET OUTPATIENT
CT894OtherANTHEM BLUE CROSS
CT894OtherANTHEM BLUE CROSS