Jacc Healthcare Center of Norwich, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

JACC HEALTHCARE CENTER OF NORWICH, LLC

Doing business as

Three Rivers

Practice address

60 Crouch Ave
Norwich, CT 06360-7329

Phone

(860) 889-2631

Fax

(860) 889-0266

NPI assigned

Oct 17, 2014

Last updated

Mar 18, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

JACC HEALTHCARE GROUP, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. John B Wynne Jr.

Title

Manager

Phone

(860) 889-0266

Specialties & licenses 1

Addresses

Other names 1

• Three Rivers Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426636800000",
    "number": "1144624289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 CROUCH AVE",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063607329",
            "telephone_number": "860-889-2631",
            "fax_number": "860-889-0266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 CROUCH AVE",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063607329",
            "telephone_number": "860-889-2631",
            "fax_number": "860-889-0266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACC HEALTHCARE CENTER OF NORWICH, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACC HEALTHCARE GROUP, LLC",
        "enumeration_date": "2014-10-17",
        "last_updated": "2015-03-18",
        "status": "A",
        "authorized_official_last_name": "WYNNE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "860-889-0266",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Three Rivers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.