Provider Demographics
NPI:1285939041
Name:ADVANCED NURSING & REHABILITATION CENTER OF NEW HAVEN LLC
Entity type:Organization
Organization Name:ADVANCED NURSING & REHABILITATION CENTER OF NEW HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAKHLOUF
Authorized Official - Middle Name:
Authorized Official - Last Name:SUISSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-744-8688
Mailing Address - Street 1:169 DAVENPORT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1319
Mailing Address - Country:US
Mailing Address - Phone:203-789-1650
Mailing Address - Fax:203-787-0071
Practice Address - Street 1:169 DAVENPORT AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1319
Practice Address - Country:US
Practice Address - Phone:203-789-1650
Practice Address - Fax:203-787-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility