Provider Demographics
NPI:1962833178
Name:CHESHIRE HOUSE NURSING AND REHABILITATION CENTER
Entity type:Organization
Organization Name:CHESHIRE HOUSE NURSING AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:DOROTHY
Authorized Official - Last Name:CREAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-754-7359
Mailing Address - Street 1:3396 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3812
Mailing Address - Country:US
Mailing Address - Phone:203-754-2161
Mailing Address - Fax:203-759-7359
Practice Address - Street 1:3396 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3812
Practice Address - Country:US
Practice Address - Phone:203-754-2161
Practice Address - Fax:203-759-7359
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RYDERS HEALTH MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003550313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility