Provider Demographics
NPI:1144624289
Name:JACC HEALTHCARE CENTER OF NORWICH, LLC
Entity type:Organization
Organization Name:JACC HEALTHCARE CENTER OF NORWICH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:WYNNE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:860-889-0266
Mailing Address - Street 1:60 CROUCH AVE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-7329
Mailing Address - Country:US
Mailing Address - Phone:860-889-2631
Mailing Address - Fax:860-889-0266
Practice Address - Street 1:60 CROUCH AVE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-7329
Practice Address - Country:US
Practice Address - Phone:860-889-2631
Practice Address - Fax:860-889-0266
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACC HEALTHCARE GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-17
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility