NPIMap

Organization Active NPI

The Jewish Home for the Elderly of Fairfield County Inc

Doing business as Mozaic Adult Day Program

  • Adult Day Care Clinic/Center
  • Bridgeport, CT
National Provider Identifier
1619189941
Registry record updated Aug 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Day Care Clinic/CenterTaxonomy code 261QA0600X
Legal business name
THE JEWISH HOME FOR THE ELDERLY OF FAIRFIELD COUNTY INC
Doing business as
Mozaic Adult Day Program
Mozaic Adult Family Living
Practice address
4200 Park Ave
Bridgeport, CT 06604-1049
Phone
(203) 365-6455
Fax
(203) 396-1108
NPI assigned
May 7, 2007
Last updated
Aug 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2024

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

Authorized official

Name
Evangelyn Peterson
Title
Controller
Phone
(203) 396-6455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X Primary

Addresses

Primary practice location

4200 Park Ave
Bridgeport, CT 06604-1049

Mailing address

4200 Park Ave
Bridgeport, CT 06604-1049
Phone (203) 365-6455

Other names 2

  • Mozaic Adult Day Program Doing business as
  • Mozaic Adult Family Living Doing business as

National Provider Directory

National Provider Directory
Tax ID family
The Jewish Home for the Elderly of Fairfield County6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723593600000",
    "number": "1619189941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 PARK AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066041049",
            "telephone_number": "203-365-6455",
            "fax_number": "203-396-1108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 PARK AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066041049",
            "telephone_number": "203-365-6455",
            "fax_number": "203-396-1108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE JEWISH HOME FOR THE ELDERLY OF FAIRFIELD COUNTY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "EVANGELYN",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "203-396-6455"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mozaic Adult Day Program",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mozaic Adult Family Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; 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.