Provider Demographics
NPI:1174696017
Name:CITY OF STAMFORD
Entity type:Organization
Organization Name:CITY OF STAMFORD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MISLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, LNHA
Authorized Official - Phone:203-322-3428
Mailing Address - Street 1:88 ROCK RIMMON ROAD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903
Mailing Address - Country:US
Mailing Address - Phone:203-322-3428
Mailing Address - Fax:
Practice Address - Street 1:88 ROCK RIMMON ROAD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06903
Practice Address - Country:US
Practice Address - Phone:203-322-3428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT716C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000007161Medicaid
CT000007161Medicaid