| NPI | 1003078734 |
|---|---|
| Other Name | SOUTH PARK INN |
| Entity Type | Organization |
| Authorized Contact | ALFREDA TURNER President And CEO 860-550-7500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CT 00000259) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2008-12-05 |