Provider Demographics
NPI:1275784753
Name:2432 ALBANY AVENUE OPERATIONS LLC
Entity Type:Organization
Organization Name:2432 ALBANY AVENUE OPERATIONS LLC
Other - Org Name:BISHOPS CORNER SKILLED NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-925-4045
Mailing Address - Street 1:2432 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2503
Mailing Address - Country:US
Mailing Address - Phone:860-236-3557
Mailing Address - Fax:860-236-4060
Practice Address - Street 1:2432 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2503
Practice Address - Country:US
Practice Address - Phone:860-236-3557
Practice Address - Fax:860-236-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2259314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000020389Medicaid
CT075248Medicare Oscar/Certification