Provider Demographics
NPI:1427049899
Name:HOME FOR THE AGED OF THE LITTLE SISTERS OF THE POOR INCORPORATED
Entity type:Organization
Organization Name:HOME FOR THE AGED OF THE LITTLE SISTERS OF THE POOR INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES/ADMIN.
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-741-0791
Mailing Address - Street 1:1365 ENFIELD STREET
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4925
Mailing Address - Country:US
Mailing Address - Phone:860-741-0791
Mailing Address - Fax:860-745-4270
Practice Address - Street 1:1365 ENFIELD STREET
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4925
Practice Address - Country:US
Practice Address - Phone:860-741-0791
Practice Address - Fax:860-741-0791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1678 RCH310400000X
CT901C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000009019Medicaid
CT000009019Medicaid