Provider Demographics
NPI:1831180116
Name:BARRE GARDENS NURSING AND REHAB LLC
Entity type:Organization
Organization Name:BARRE GARDENS NURSING AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:AKIVA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLATZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-505-0000
Mailing Address - Street 1:99 W HAWTHORNE AVENUE
Mailing Address - Street 2:SUITE 508
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-6101
Mailing Address - Country:US
Mailing Address - Phone:516-505-0000
Mailing Address - Fax:646-943-5896
Practice Address - Street 1:378 PROSPECT STREET
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-5421
Practice Address - Country:US
Practice Address - Phone:802-476-4166
Practice Address - Fax:802-479-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0270000189314000000X
VT314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0475037Medicaid
VT475037BMedicare Oscar/Certification
VT0475037Medicaid