Provider Demographics
NPI:1467912105
Name:BEAR MT EAST LONGMEADOW LLC
Entity Type:Organization
Organization Name:BEAR MT EAST LONGMEADOW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNNE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:860-880-8202
Mailing Address - Street 1:130 S MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06787-1741
Mailing Address - Country:US
Mailing Address - Phone:860-880-8202
Mailing Address - Fax:860-880-8205
Practice Address - Street 1:32 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2803
Practice Address - Country:US
Practice Address - Phone:413-525-1893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility