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SIMONETTI REALTY INC NPI 1578784658


NPI Information

NPI: 1578784658
Provider Name: SIMONETTI REALTY INC

Doing Business As: MARSHALL LANE MANOR

Classification: Nursing Facility/Intermediate Care Facility - 313M00000X
Entity Type: Organization
Address:
101 MARSHALL LN
DERBY, CT
ZIP 06418
Phone: (203) 734-3393
Get Directions

SIMONETTI REALTY INC is a nursing facility intermediate care facility in Derby, CT. The provider is an institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. SIMONETTI REALTY INC NPI is 1578784658. The provider is registered as an organization entity type.
The provider Is Doing Business As Marshall Lane Manor.

The provider's business location address is:

101 MARSHALL LN
DERBY, CT
ZIP 06418-347
Phone: (203) 734-3393
Fax: (203) 734-2100

The provider's authorized official is Patricia Ann Mccallum .
The authorized official title is Office Manager and has the following contact phone number (203) 734-3393.

The enumeration date for this NPI number is 5/2/2007 and was last updated on 1/18/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1313M00000XNursing Facility/Intermediate Care Facility102RHCONNECTICUTYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11115MEDICARE UPINCONNECTICUT
2075430MEDICARE ID-TYPE UNSPECIFIEDCONNECTICUTMEDICARE
3000091025MEDICAIDCONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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