Provider Demographics
NPI:1467401075
Name:MONTOWESE HEALTH & REHABILILTATION CENTER
Entity Type:Organization
Organization Name:MONTOWESE HEALTH & REHABILILTATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FAROOQ
Authorized Official - Middle Name:H
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-624-3303
Mailing Address - Street 1:163 QUINNIPIAC AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3623
Mailing Address - Country:US
Mailing Address - Phone:203-624-3303
Mailing Address - Fax:203-789-4433
Practice Address - Street 1:163 QUINNIPIAC AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3623
Practice Address - Country:US
Practice Address - Phone:203-624-3303
Practice Address - Fax:203-789-4433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1015-C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0210157Medicaid
CT0210157Medicaid