Organization
FAIRVIEW HEALTH OF SOUTHPORT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY DOLCE CONTROLLER (CONTROLLER)
(203) 259-7894
Entity
Organization
Contact information
Practice address
930 MILL HILL TER, SOUTHPORT, CT 06890-1265
(203) 259-7894
(203) 254-3720
Mailing address
930 MILL HILL TER, SOUTHPORT, CT 06890-1265
(203) 259-7894
(203) 254-3720
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2307-C
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000008508
—
CT
Enumeration date
10/16/2006
Last updated
10/15/2012
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