Eastern CT Health Systems Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1048C Issued in CT

Legal business name

EASTERN CT HEALTH SYSTEMS INC

Doing business as

Fountainview Care Center

Practice address

88 Clark Lane
Waterford, CT 06385

Phone

(860) 442-0471

Fax

(860) 440-3574

NPI assigned

Sep 21, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. James Michael Pettey, LNHA

Title

Administrator

Phone

(860) 442-0471

Specialties & licenses 1

Addresses

Other names 1

• Fountainview Care Center Doing business as

Locations

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780670299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88 CLARK LANE",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "06385",
            "telephone_number": "860-442-0471",
            "fax_number": "860-440-3574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 CLARK LANE",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "06385",
            "telephone_number": "860-442-0471",
            "fax_number": "860-440-3574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN CT HEALTH SYSTEMS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETTEY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "860-442-0471",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "1048C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fountainview Care Center",
            "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 Aug 22, 2020; 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.