NPIMap

Organization Active NPI

Staywell Healthcare, Inc

  • General Practice Physician
  • Waterbury, CT
National Provider Identifier
1669629911
Registry record updated Aug 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
STAYWELL HEALTHCARE, INC
Practice address
74 Central Ave
Waterbury, CT 06702-1207
Phone
(203) 756-8021
Fax
(203) 596-9038
NPI assigned
Aug 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2008

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

Authorized official

Name
Mr. Donald Thompson
Title
President
Phone
(203) 756-8021

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

74 Central Ave
Waterbury, CT 06702-1207

Mailing address

80 Phoenix Ave Ste 201
Waterbury, CT 06702-1418
Phone (203) 756-8021

Other names 1

  • Staywell/Salvation Army Other name

National Provider Directory

National Provider Directory
Tax ID family
Staywell Health Care Inc6 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.

Locations

74 Central Ave
Waterbury, CT 06702

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1219104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219104000000",
    "number": "1669629911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 PHOENIX AVE STE 201",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021418",
            "telephone_number": "203-756-8021",
            "fax_number": "203-596-9038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 CENTRAL AVE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021207",
            "telephone_number": "203-756-8021",
            "fax_number": "203-596-9038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAYWELL HEALTHCARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-19",
        "last_updated": "2008-08-19",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-756-8021",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Staywell/Salvation Army",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Waterbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; 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.