Jacc Healthcare Center of Windham, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

JACC HEALTHCARE CENTER OF WINDHAM, LLC

Doing business as

Vanderman Place

Practice address

595 Valley St
Willimantic, CT 06226-1901

Phone

(860) 450-7060

Fax

(860) 450-7070

NPI assigned

Oct 14, 2014

Organization subpart

Yes

Parent organization

JACC HEALTHCARE GROUP, LLCAs reported in NPPES

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

Authorized official

Name

Mr. Scott L Ziskin

Title

President & Ceo

Phone

(860) 450-7060

Specialties & licenses 1

Addresses

Other names 1

• Vanderman Place Doing business as

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

{
    "created_epoch": "1413244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426636800000",
    "number": "1942604392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 VALLEY ST",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062261901",
            "telephone_number": "860-450-7060",
            "fax_number": "860-450-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 VALLEY ST",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062261901",
            "telephone_number": "860-450-7060",
            "fax_number": "860-450-7070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACC HEALTHCARE CENTER OF WINDHAM, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACC HEALTHCARE GROUP, LLC",
        "enumeration_date": "2014-10-14",
        "last_updated": "2015-03-18",
        "status": "A",
        "authorized_official_last_name": "ZISKIN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "860-450-7060",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vanderman Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Iacampo, PT
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• Mark I Jacobs, MD
• Colby S Jansing
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• Skilled Nursing Facility in Willimantic, CT
• Providers in Willimantic, 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 Mar 18, 2015; 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.