NPIMap

Organization Active NPI

Wadsworth Glen, Inc

  • Skilled Nursing Facility
  • Middletown, CT
National Provider Identifier
1730451501
Registry record updated Apr 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2025C Issued in CT
Legal business name
WADSWORTH GLEN, INC
Practice address
30 Boston Rd
Middletown, CT 06457-3543
Phone
(860) 346-9299
Fax
(860) 343-5030
NPI assigned
Feb 8, 2012
Organization subpart
Yes
Parent organization
ATHENA HEALTH CARE ASSOCIATESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 12, 2013

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

Authorized official

Name
Michael E Mosier
Title
Cfo
Phone
(860) 751-3900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2025C CT Primary

Addresses

Primary practice location

30 Boston Rd
Middletown, CT 06457-3543

Mailing address

30 Boston Rd
Middletown, CT 06457-3543
Phone (860) 346-9299

Other identifiers 1

IdentifierTypeStateIssuer
000020256MedicaidCT

Other names 1

  • Wadsworth Glen Health Care & Rehab Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wadsworth Glen Health Care Reh2 organizations share this tax ID, including this one
Part of
Athena Health Care Associates Inc

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1328659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365724800000",
    "number": "1730451501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 BOSTON RD",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573543",
            "telephone_number": "860-346-9299",
            "fax_number": "860-343-5030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 BOSTON RD",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573543",
            "telephone_number": "860-346-9299",
            "fax_number": "860-343-5030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WADSWORTH GLEN, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ATHENA HEALTH CARE ASSOCIATES",
        "enumeration_date": "2012-02-08",
        "last_updated": "2013-04-12",
        "status": "A",
        "authorized_official_last_name": "MOSIER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "860-751-3900"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "2025C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000020256",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wadsworth Glen Health Care & Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Middletown, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2013; 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.