Organization
GENTIVA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAMISHA S CORLEY M.D. (CLINICAL SUPERVISOR)
(860) 528-4037
Entity
Organization
Contact information
Practice address
20 CHURCH ST, SUITE 11, HARTFORD, CT 06103-1246
(860) 528-4038
Mailing address
52 DEERWOOD LN, 11, WATERBURY, CT 06704-6110
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
CT
310400000X
Assisted Living Facility
1417097593
CT
Other
Enumeration date
03/01/2016
Last updated
03/01/2016
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