Organization
STAYWELL HEALTH CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD THOMPSON (CEO/PRESIDENT)
(203) 756-8021
Entity
Organization
Contact information
Practice address
30 CHURCH ST, NAUGATUCK, CT 06770-4112
(203) 805-4929
(844) 668-4620
Mailing address
30 CHURCH ST, NAUGATUCK, CT 06770-4112
(203) 805-4929
(844) 668-4620
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0787
CT
208000000X
Pediatrics Physician
0787
CT
261QD0000X
Dental Clinic/Center
—
CT
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
CT
261QH0100X
Health Service Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235968
—
CT
05
—
004235976
—
CT
05
—
004235984
—
CT
01
—
1154342335
ANTHEM BCBS
CT
Enumeration date
09/09/2016
Last updated
01/09/2020
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