1013947795 NPI number — LUDLOWE CENTER FOR HEALTH AND REHABILITATION, LLC

Table of content: (NPI 1013947795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013947795 NPI number — LUDLOWE CENTER FOR HEALTH AND REHABILITATION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUDLOWE CENTER FOR HEALTH AND REHABILITATION, 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:
LUDLOWE CENTER FOR HEALTH AND REHABILITATION
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:
1013947795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 JEFFERSON STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06825-1019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-372-4501
Provider Business Mailing Address Fax Number:
203-371-2725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 JEFFERSON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06825-1019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-372-4501
Provider Business Practice Location Address Fax Number:
203-371-2725
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOKOW
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT/CFO
Authorized Official Telephone Number:
516-705-4802

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 2323 , 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: 000006080 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0006080 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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