Provider Demographics
NPI:1316005242
Name:MARLBOROUGH HEALTH CARE CENTER.,INC
Entity type:Organization
Organization Name:MARLBOROUGH HEALTH CARE CENTER.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEROLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-295-9531
Mailing Address - Street 1:85 STAGE HARBOR ROAD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447
Mailing Address - Country:US
Mailing Address - Phone:860-295-9531
Mailing Address - Fax:860-295-9923
Practice Address - Street 1:85 STAGE HARBOR ROAD
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447
Practice Address - Country:US
Practice Address - Phone:860-295-9531
Practice Address - Fax:860-295-9923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2105C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000021056Medicaid
CT075384Medicare ID - Type Unspecified