Provider Demographics
NPI:1124336235
Name:B & W RESIDENTIAL CARE SERVICES
Entity type:Organization
Organization Name:B & W RESIDENTIAL CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER (CEO)
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:BURCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:860-233-4971
Mailing Address - Street 1:58 SOUTH WHITNEY STREET
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-8481
Mailing Address - Country:US
Mailing Address - Phone:860-233-4971
Mailing Address - Fax:
Practice Address - Street 1:902 AMBER TRL
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-8481
Practice Address - Country:US
Practice Address - Phone:860-233-4971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities