07D0674634 CLIA NUMBER - COOK WILLOW CONVALESCENT HOSPITAL, INC

Laboratory Demographics

CLIA Number: 07D0674634

Facility Name: COOK WILLOW CONVALESCENT HOSPITAL, INC

Facility Address:
81 HILLSIDE AVE
PLYMOUTH, CT
ZIP 06782
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Facility Phone Number: 860 283-8208

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver

NPI Number: 1205979457

Taxonomy: 314000000X - Skilled Nursing Facility
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

CLIA Record

Field Name	Field Value
CLIA Number	07D0674634
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	COOK WILLOW CONVALESCENT HOSPITAL, INC
Street	81 HILLSIDE AVE
City	PLYMOUTH
State	CT
ZIP	06782
Phone	860 283-8208
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024