Provider Demographics
NPI:1013583483
Name:WATERBURY CENTER FOR NURSING & REHABILITATION, LLC
Entity Type:Organization
Organization Name:WATERBURY CENTER FOR NURSING & REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:MENAJEM
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-882-6400
Mailing Address - Street 1:177 WHITEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-1545
Mailing Address - Country:US
Mailing Address - Phone:203-707-5800
Mailing Address - Fax:
Practice Address - Street 1:177 WHITEWOOD RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-1545
Practice Address - Country:US
Practice Address - Phone:203-707-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000009001Medicaid