Provider Demographics
NPI:1770950495
Name:WINDSOR HEALTH AND REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:WINDSOR HEALTH AND REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALATISE
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:860-688-7211
Mailing Address - Street 1:581 POQUONOCK AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2202
Mailing Address - Country:US
Mailing Address - Phone:860-688-7211
Mailing Address - Fax:
Practice Address - Street 1:581 POQUONOCK AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2202
Practice Address - Country:US
Practice Address - Phone:860-688-7211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT509589Medicaid
075011Medicare Oscar/Certification