1740228964 NPI number — HBR TRUMBULL LLC

Table of content: (NPI 1740228964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740228964 NPI number — HBR TRUMBULL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HBR TRUMBULL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST. JOSEPH'S MANOR REHABILITATION AND NURSING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740228964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 SUN AVE NE
Provider Second Line Business Mailing Address:
COMPLIANCE DEPARTMENT
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87109-4373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-468-5604
Provider Business Mailing Address Fax Number:
505-468-4681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6448 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRUMBULL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06611-2075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-268-6204
Provider Business Practice Location Address Fax Number:
203-268-5271
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERG
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
T
Authorized Official Title or Position:
ASSISTANT SECRETARY
Authorized Official Telephone Number:
505-468-4742

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 124Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: 0042 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311ZA0620X , with the licence number: 1690-RCH , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 684-C , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NO NUMBER . This is a "RES CARE PAID BY DSS-NO #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 6841 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004261682 . This is a "SWACCA ADULT DAYCARE" identifier . This identifiers is of the category "OTHER".




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