Provider Demographics
NPI:1013947795
Name:LUDLOWE CENTER FOR HEALTH AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:LUDLOWE CENTER FOR HEALTH AND REHABILITATION, LLC
Other - Org Name:LUDLOWE CENTER FOR HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-705-4802
Mailing Address - Street 1:118 JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1019
Mailing Address - Country:US
Mailing Address - Phone:203-372-4501
Mailing Address - Fax:203-371-2725
Practice Address - Street 1:118 JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-1019
Practice Address - Country:US
Practice Address - Phone:203-372-4501
Practice Address - Fax:203-371-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
CT2323314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000006080Medicaid
CT0006080Medicaid
CT000006080Medicaid