Provider Demographics
NPI:1528224847
Name:FARMINGTON REHAB CENTER, LLC
Entity Type:Organization
Organization Name:FARMINGTON REHAB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:HAGGERTY
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:860-677-1671
Mailing Address - Street 1:416 COLT HWY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2534
Mailing Address - Country:US
Mailing Address - Phone:860-677-1671
Mailing Address - Fax:860-677-2217
Practice Address - Street 1:416 COLT HWY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2534
Practice Address - Country:US
Practice Address - Phone:860-677-1671
Practice Address - Fax:860-677-2217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2332314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000009241Medicaid
CT075419Medicare Oscar/Certification