Shady Knoll Health Center, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2107-C Issued in CT

Legal business name

SHADY KNOLL HEALTH CENTER, INC

Practice address

41 Skokorat St
Seymour, CT 06483-3826

Phone

(203) 881-2555

Fax

(203) 881-0853

NPI assigned

Mar 28, 2006

Organization subpart

No

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

Authorized official

Name

Lawrence G. Santilli

Title

President/Ceo

Phone

(860) 751-3900

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676505600000",
    "number": "1225098643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 SKOKORAT ST",
            "city": "SEYMOUR",
            "state": "CT",
            "postal_code": "064833826",
            "telephone_number": "203-881-2555",
            "fax_number": "203-881-0853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 SKOKORAT ST",
            "city": "SEYMOUR",
            "state": "CT",
            "postal_code": "064833826",
            "telephone_number": "203-881-2555",
            "fax_number": "203-881-0853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY KNOLL HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-28",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A",
        "authorized_official_last_name": "SANTILLI",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "860-751-3900"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "2107-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000021072",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000095267",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seybridge Pharmacy Inc
• Seymour Ambulance Association Inc
• Seymour Optometric Center, LLC
• Shady Knoll Acquisition Operator LLC
• Shady Knoll Health Care Center, Inc.
• Nagesh D Shrestha, D.D.S.
• Susan P Sidway, MS, LMFT
• Tanya Ronnette Simpson
• Solara ABA CT LLC
• Sycamore Counseling Services LLC

• Skilled Nursing Facility in Seymour, CT
• Providers in Seymour, CT by specialty
• Skilled Nursing Facility in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; 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.