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Organization
COVENANT HOME, INC. (CONNECTICUT)
Active
Organization
COVENANT HOME, INC. (CONNECTICUT)
Active
Other names
Pilgrim Manor
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH MALZAHN (VICE PRESIDENT OF HEALTH SERVICES)
(773) 878-4430
Entity
Organization
Contact information
Practice address
52 MISSIONARY ROAD, CROMWELL, CT 06416
(860) 635-2690
(860) 632-2407
Mailing address
52 MISSIONARY ROAD, CROMWELL, CT 06416
(860) 635-2690
(860) 632-2407
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
966-C
CT
314000000X
Skilled Nursing Facility
Primary
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000007260
—
CT
01
—
0092064
ICF MEDICAID
CT
05
—
0092064
—
CT
Enumeration date
09/15/2006
Last updated
09/06/2016
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