Organization
SPECTRUM HEALTHCARE DERBY, LLC
Active
Other names
Birmingham Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOWARD WILLIAM DICKSTEIN PHD (CHIEF EXECUTIVE OFFICER)
(860) 871-5454
Entity
Organization
Contact information
Practice address
210 CHATFIELD ST, DERBY, CT 06418-1150
(860) 871-5454
(860) 871-5757
Mailing address
210 CHATFIELD ST, DERBY, CT 06418-1150
(860) 871-5454
(860) 871-5757
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2236
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010587
—
CT
01
—
2236
STATE LICENSE
CT
Enumeration date
11/07/2005
Last updated
08/12/2008
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