Provider Demographics
NPI:1033267331
Name:MONSIGNOR BOJNOWSKI MANOR, INC.
Entity Type:Organization
Organization Name:MONSIGNOR BOJNOWSKI MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALVIETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-229-0336
Mailing Address - Street 1:50 PULASKI STREET
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-3565
Mailing Address - Country:US
Mailing Address - Phone:860-229-0336
Mailing Address - Fax:860-229-3252
Practice Address - Street 1:50 PULASKI STREET
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-3565
Practice Address - Country:US
Practice Address - Phone:860-229-0336
Practice Address - Fax:860-229-3252
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONSIGNOR BOJNOWSKI MANOR, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-05
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT933C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000009332Medicaid
CT716OtherANTHEM PROVIDER ID
CT716OtherANTHEM BLUE CROSS
CT716OtherANTHEM PROVIDER ID