Provider Demographics
NPI:1336599497
Name:ADVANCED CENTER FOR NURSING & REHABILITATION LLC
Entity Type:Organization
Organization Name:ADVANCED CENTER FOR NURSING & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MENAJEM
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-882-6400
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2378314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000000323Medicaid
075348Medicare UPIN