Provider Demographics
NPI:1821541194
Name:WV-PARKWAY PAVILION LLC
Entity Type:Organization
Organization Name:WV-PARKWAY PAVILION LLC
Other - Org Name:PARKWAY PAVILION HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:A
Authorized Official - Last Name:DENNEHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-464-7729
Mailing Address - Street 1:1157 ENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4367
Mailing Address - Country:US
Mailing Address - Phone:860-745-1641
Mailing Address - Fax:
Practice Address - Street 1:1157 ENFIELD ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4367
Practice Address - Country:US
Practice Address - Phone:860-745-1641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WACHUSETT VENTURES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2395314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility