Basic Information
| Provider Information | |||||||||
| NPI: | 1104941806 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORNELL SCOTT HILL HEALTH CORPORATION | ||||||||
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| OtherOrganizationName: | SOUTH CENTRAL REHAB CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7720 | ||||||||
| Address2: | CREDENTIALING SPECIALIST | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065190720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035033174 | ||||||||
| FaxNumber: | 2035036515 | ||||||||
| Practice Location | |||||||||
| Address1: | 232 CEDAR ST. | ||||||||
| Address2: | SOUTH CENTRAL REHABILITATION CENTER | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065191610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035033300 | ||||||||
| FaxNumber: | 2034013352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 04/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | GONZALEZ | ||||||||
| AuthorizedOfficialFirstName: | SOL | ||||||||
| AuthorizedOfficialMiddleName: | MARIA | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 2035033174 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CORNELL SCOTT-HILL HEALTH CORPORATION | ||||||||
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| NPICertificationDate: | 04/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | SA-0122 | CT | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.