Provider Demographics
NPI:1467679639
Name:SUBACUTE CENTER OF BRISTOL LLC
Entity Type:Organization
Organization Name:SUBACUTE CENTER OF BRISTOL LLC
Other - Org Name:VILLAGE GREEN OF BRISTOLREHABILITATION AND HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCILLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-608-6100
Mailing Address - Street 1:538 PRESTON AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4851
Mailing Address - Country:US
Mailing Address - Phone:203-608-6100
Mailing Address - Fax:203-639-3574
Practice Address - Street 1:23 FAIR STREET
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:CT
Practice Address - Zip Code:06010-5531
Practice Address - Country:US
Practice Address - Phone:860-589-2923
Practice Address - Fax:860-589-3148
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONNECTICUT SUBACUTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-19
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2224-C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000520165Medicaid
CT075198001Medicare Oscar/Certification
CT000520165Medicaid