Provider Demographics
NPI:1093173486
Name:HAMDEN REHABILITATION LLC
Entity Type:Organization
Organization Name:HAMDEN REHABILITATION LLC
Other - Org Name:HAMDEN REHABILITATION AND HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MORDECHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASS
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:203-281-7555
Mailing Address - Street 1:1270 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1330
Mailing Address - Country:US
Mailing Address - Phone:203-281-7555
Mailing Address - Fax:203-281-3827
Practice Address - Street 1:1270 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-1330
Practice Address - Country:US
Practice Address - Phone:203-281-7555
Practice Address - Fax:203-281-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000009902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000009902Medicaid