Provider Demographics
NPI:1538225909
Name:CHESTNUT POINT CARE CENTER LLC
Entity type:Organization
Organization Name:CHESTNUT POINT CARE CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-570-2140
Mailing Address - Street 1:171 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06088-9682
Mailing Address - Country:US
Mailing Address - Phone:860-292-5394
Mailing Address - Fax:860-623-7928
Practice Address - Street 1:171 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06088-9682
Practice Address - Country:US
Practice Address - Phone:860-292-5394
Practice Address - Fax:860-623-7928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2314314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000090209Medicaid
CT74AOtherBC/BS
CT1429528OtherAETNA
CT912950OtherCONNECTICARE
CT912950OtherCONNECTICARE