Organization
COOK WILLOW CONVALESCENT HOSPITAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN A. MACDONALD R.N. (ADMINISTRATOR)
(860) 283-8208
Entity
Organization
Contact information
Practice address
81 HILLSIDE AVE, PLYMOUTH, CT 06782-2305
(860) 283-8208
(860) 283-6667
Mailing address
81 HILLSIDE AVE, PLYMOUTH, CT 06782-2305
(860) 283-8208
(860) 283-6667
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
932-C
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
649
ANTHEM BCBS
CT
01
—
IV5659
HEALTHNET PROVIDER
CT
01
—
V631P-3901
VETERAN AFFAIRS CONTRACT
CT
Enumeration date
02/15/2007
Last updated
08/22/2020
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