Provider Demographics
NPI:1336151547
Name:MANCHESTER HEALTH CENTER, INC
Entity Type:Organization
Organization Name:MANCHESTER HEALTH CENTER, INC
Other - Org Name:CRESTFIELD REHABILITATION & FENWOOD MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-643-5151
Mailing Address - Street 1:565 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-2409
Mailing Address - Country:US
Mailing Address - Phone:860-643-5151
Mailing Address - Fax:860-643-3608
Practice Address - Street 1:565 VERNON ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2409
Practice Address - Country:US
Practice Address - Phone:860-643-5151
Practice Address - Fax:860-643-3608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1014C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT075013Medicare ID - Type Unspecified