Basic Information
| Provider Information | |||||||||
| NPI: | 1932103694 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAYBROOK HEALTH CARE CENTER, INC. | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SAYBROOK CONVALESCENT HOSPITAL, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1775 BOSTON POST RD. | ||||||||
| Address2: | |||||||||
| City: | OLD SAYBROOK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064751643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603996216 | ||||||||
| FaxNumber: | 8603994053 | ||||||||
| Practice Location | |||||||||
| Address1: | 1775 BOSTON POST RD | ||||||||
| Address2: | |||||||||
| City: | OLD SAYBROOK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064751643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603996216 | ||||||||
| FaxNumber: | 8603994053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2005 | ||||||||
| LastUpdateDate: | 10/20/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HAMBLEY | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO, APPLE HEALTH CARE | ||||||||
| AuthorizedOfficialTelephone: | 8606789755 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | APPLE HEALTH CARE, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 725-C | CT | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 314000000X | 0725-CC | CT | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 7252 | 05 | CT | MEDICAID | 000007252 | 05 | CT | MEDICAID |