Provider Demographics
NPI:1831348226
Name:THE HEARTH AT GARDENSIDE
Entity type:Organization
Organization Name:THE HEARTH AT GARDENSIDE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SALSA
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:B
Authorized Official - Last Name:TRACEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:203-483-7260
Mailing Address - Street 1:173 ALPS RD
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-4742
Mailing Address - Country:US
Mailing Address - Phone:203-483-7260
Mailing Address - Fax:203-483-7752
Practice Address - Street 1:173 ALPS RD
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-4742
Practice Address - Country:US
Practice Address - Phone:203-483-7260
Practice Address - Fax:203-483-7752
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTH MANAGEMENT CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0072310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility