Organization
JEWISH HOME FOR AGED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE MARIE BOUSQUET (CFO)
(703) 789-1650
Entity
Organization
Contact information
Practice address
169 DAVENPORT AVE, NEW HAVEN, CT 06519
(203) 789-1650
(203) 787-0071
Mailing address
169 DAVENPORT AVE, NEW HAVEN, CT 06519
(203) 789-1650
(203) 787-0071
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
32-C
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000323
—
CT
01
—
706
ANTHEM BC/BS OF CT
CT
01
—
71-01006
EVERCARE HMO
CT
Enumeration date
10/03/2005
Last updated
08/14/2008
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