Provider Demographics
NPI:1811998495
Name:TOWN OF WESTBROOK
Entity type:Organization
Organization Name:TOWN OF WESTBROOK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:T
Authorized Official - Last Name:LOVELETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CHCE
Authorized Official - Phone:860-399-3088
Mailing Address - Street 1:866 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06498-1881
Mailing Address - Country:US
Mailing Address - Phone:860-399-3088
Mailing Address - Fax:860-399-3096
Practice Address - Street 1:866 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-1881
Practice Address - Country:US
Practice Address - Phone:860-399-3088
Practice Address - Fax:860-399-3096
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF WESTBROOK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-09
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC81851251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004042479Medicaid
CT2V7757OtherHEALTH NET
CT273OtherANTHEM B/C B/S
CT004073383OtherAASCC
CT273OtherANTHEM B/C B/S
CT004042479Medicaid