Provider Demographics
NPI:1982609673
Name:CHESTELM HEALTH CARE, INC
Entity type:Organization
Organization Name:CHESTELM HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-873-1455
Mailing Address - Street 1:534 TOWN ST
Mailing Address - Street 2:
Mailing Address - City:MOODUS
Mailing Address - State:CT
Mailing Address - Zip Code:06469-1101
Mailing Address - Country:US
Mailing Address - Phone:860-873-1455
Mailing Address - Fax:860-873-2307
Practice Address - Street 1:534 TOWN ST
Practice Address - Street 2:
Practice Address - City:MOODUS
Practice Address - State:CT
Practice Address - Zip Code:06469-1101
Practice Address - Country:US
Practice Address - Phone:860-873-1455
Practice Address - Fax:860-873-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X, 2083X0100X, 235Z00000X
CT2196-C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000010298Medicaid
CT000091793Medicaid
CT000010298Medicaid