Provider Demographics
NPI:1316207582
Name:COLONIAL HEALTH & REHAB CENTER OF PLAINFIELD, LLC
Entity Type:Organization
Organization Name:COLONIAL HEALTH & REHAB CENTER OF PLAINFIELD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-230-8476
Mailing Address - Street 1:13730 WHISPERING LAKES LN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-1411
Mailing Address - Country:US
Mailing Address - Phone:860-230-8476
Mailing Address - Fax:888-600-0201
Practice Address - Street 1:16 WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1036
Practice Address - Country:US
Practice Address - Phone:860-564-4081
Practice Address - Fax:860-564-1472
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLONIAL HEALTH & REHAB, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2003-C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000020032Medicaid
CT075310Medicare PIN