Fairview Health of Southport, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2307-C Issued in CT

Legal business name

FAIRVIEW HEALTH OF SOUTHPORT, LLC

Practice address

930 Mill Hill Ter
Southport, CT 06890-1265

Phone

(203) 259-7894

Fax

(203) 254-3720

NPI assigned

Oct 16, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Timothy Dolce, CONTROLLER

Title

Controller

Phone

(203) 259-7894

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350259200000",
    "number": "1811087018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 MILL HILL TER",
            "city": "SOUTHPORT",
            "state": "CT",
            "postal_code": "068901265",
            "telephone_number": "203-259-7894",
            "fax_number": "203-254-3720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 MILL HILL TER",
            "city": "SOUTHPORT",
            "state": "CT",
            "postal_code": "068901265",
            "telephone_number": "203-259-7894",
            "fax_number": "203-254-3720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRVIEW HEALTH OF SOUTHPORT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2012-10-15",
        "status": "A",
        "authorized_official_last_name": "DOLCE",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "203-259-7894",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CONTROLLER"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "2307-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000008508",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Southport, CT
• Providers in Southport, 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 Oct 15, 2012; 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.