Provider Demographics
NPI:1669474961
Name:GROVE MANOR NURSING HOME, INC.
Entity Type:Organization
Organization Name:GROVE MANOR NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:ALICIENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-753-7205
Mailing Address - Street 1:145 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-2202
Mailing Address - Country:US
Mailing Address - Phone:203-753-7205
Mailing Address - Fax:203-753-6177
Practice Address - Street 1:145 GROVE ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-2202
Practice Address - Country:US
Practice Address - Phone:203-753-7205
Practice Address - Fax:203-753-6177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT494C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT075096Medicare ID - Type Unspecified