Provider Demographics
NPI:1407274103
Name:CH-PARKWAY PAVILLION LLC
Entity Type:Organization
Organization Name:CH-PARKWAY PAVILLION LLC
Other - Org Name:PARKWAY PAVILION HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-801-7600
Mailing Address - Street 1:1157 ENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4367
Mailing Address - Country:US
Mailing Address - Phone:860-745-1641
Mailing Address - Fax:
Practice Address - Street 1:1157 ENFIELD ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4367
Practice Address - Country:US
Practice Address - Phone:860-745-1641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHESTNUT HEALTH AND REHABILITATION GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-01
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2213C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT075195Medicare Oscar/Certification