Organization
COVENANT HOME, INC. (CONNECTICUT)
Active
Other names
Pilgrim Manor
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH MALZAHN (VICE PRESIDENT OF HEALTH SERVICES)
(773) 878-4430
Entity
Organization
Contact information
Practice address
52 MISSIONARY ROAD, CROMWELL, CT 06416
(860) 635-2690
(860) 632-2407
Mailing address
52 MISSIONARY ROAD, CROMWELL, CT 06416
(860) 635-2690
(860) 632-2407
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
966-C
CT
314000000X
Skilled Nursing Facility
Primary
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000007260
—
CT
01
—
0092064
ICF MEDICAID
CT
05
—
0092064
—
CT
Enumeration date
09/15/2006
Last updated
09/06/2016
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