Provider Demographics
NPI:1912969601
Name:ABBOTT TERRACE HEALTH CENTER
Entity Type:Organization
Organization Name:ABBOTT TERRACE HEALTH CENTER
Other - Org Name:ABBOTT TERRACE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANTILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-751-3900
Mailing Address - Street 1:44 ABBOTT TER
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-1431
Mailing Address - Country:US
Mailing Address - Phone:203-755-4870
Mailing Address - Fax:203-755-9016
Practice Address - Street 1:44 ABBOTT TER
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1431
Practice Address - Country:US
Practice Address - Phone:203-755-4870
Practice Address - Fax:203-755-9016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENA HEALTH CARE ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-06
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1089-C261QA0600X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000010892Medicaid
CT000092189Medicaid
CT000010892Medicaid