MEDICARE: 245 ORANGE AVENUE OPERATING COMPANY II LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	2278	CT

General Provider Information

NPI Number	:	1306844246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	245 ORANGE AVENUE OPERATING COMPANY II LLC

Provider Business Mailing Address
First Line	:	245 ORANGE AVE
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06460-2104
Country	:	US
Telephone Number	:	203-876-5123
Fax Number	:	203-876-5129

Provider Business Practice Location Address
First Line	:	245 ORANGE AVE
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06460-2104
Country	:	US
Telephone Number	:	203-876-5123
Fax Number	:	203-876-5129

Authorized Official
Title or Position	:	EXECUTIVE VP
Name	:	KEVIN BRESLIN
Credential	:
Telephone Number	:	201-242-4004

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	08/22/2020

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