Provider Demographics
NPI:1699799130
Name:PIERCE MEMORIAL BAPTIST HOME, INC.
Entity type:Organization
Organization Name:PIERCE MEMORIAL BAPTIST HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-237-1206
Mailing Address - Street 1:44 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:CT
Mailing Address - Zip Code:06234-0326
Mailing Address - Country:US
Mailing Address - Phone:860-774-9050
Mailing Address - Fax:860-774-2028
Practice Address - Street 1:44 CANTERBURY ROAD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:CT
Practice Address - Zip Code:06234
Practice Address - Country:US
Practice Address - Phone:860-774-9050
Practice Address - Fax:860-774-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT600C313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
000090720OtherICF
075243Medicare ID - Type Unspecified