Healthcare Provider Details

I. General information

NPI: 1629004395
Provider Name (Legal Business Name): AVON CONVALESCENT HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 W AVON RD
AVON CT
06001-2906
US

IV. Provider business mailing address

652 W AVON RD
AVON CT
06001-2906
US

V. Phone/Fax

Practice location:
  • Phone: 860-673-2521
  • Fax: 860-675-1587
Mailing address:
  • Phone: 860-673-2521
  • Fax: 860-675-1587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number938-C
License Number StateCT

VIII. Authorized Official

Name: MR. RUSSELL SCHWARTZ
Title or Position: V.P. / DIRECTOR OF OPERATION
Credential:
Phone: 860-490-9855