Provider Demographics
NPI:1609861368
Name:GERIATRICS INC BEL AIR MANOR
Entity Type:Organization
Organization Name:GERIATRICS INC BEL AIR MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SBRYHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-381-1327
Mailing Address - Street 1:256 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4416
Mailing Address - Country:US
Mailing Address - Phone:203-666-4175
Mailing Address - Fax:203-666-7046
Practice Address - Street 1:256 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4416
Practice Address - Country:US
Practice Address - Phone:203-666-4175
Practice Address - Fax:203-666-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2108C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTO75393Medicare UPIN