Provider Demographics
NPI:1790843100
Name:BIDWELL CARE CENTER LLC
Entity type:Organization
Organization Name:BIDWELL CARE CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-570-2140
Mailing Address - Street 1:333 BIDWELL ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6469
Mailing Address - Country:US
Mailing Address - Phone:860-533-3086
Mailing Address - Fax:860-645-4888
Practice Address - Street 1:333 BIDWELL ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6469
Practice Address - Country:US
Practice Address - Phone:860-533-3086
Practice Address - Fax:860-645-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2290314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
887OtherBC/BS
918282OtherCONNECTICARE
CT000020123Medicaid
CT000020123Medicaid