Organization
STATE OF CT.- OFFICE OF THE COMPTROLLER
Active
Other names
South Region - Durant/Riverview
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CRESCENTINO SECCHIAROLI (FISCAL ADMINISTRATOR)
(860) 418-8712
Entity
Organization
Contact information
Practice address
240 ORAL SCHOOL RD, MYSTIC, CT 06355-1208
(860) 572-1537
Mailing address
240 ORAL SCHOOL RD, MYSTIC, CT 06355-1208
(860) 572-1537
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006732128
—
CT
Enumeration date
01/23/2007
Last updated
03/25/2016
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