Provider Demographics
NPI:1831640283
Name:FITCHBURG GARDENS FOR NURSING AND REHABILITATION LLC
Entity Type:Organization
Organization Name:FITCHBURG GARDENS FOR NURSING AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ARI
Authorized Official - Middle Name:
Authorized Official - Last Name:STAWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-505-0000
Mailing Address - Street 1:99 W HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-6163
Mailing Address - Country:US
Mailing Address - Phone:516-505-0000
Mailing Address - Fax:
Practice Address - Street 1:94 SUMMER ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-5761
Practice Address - Country:US
Practice Address - Phone:516-505-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0085314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility