Healthcare Provider Details

I. General information

NPI: 1316153299
Provider Name (Legal Business Name): BRISTOL CROSSINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 BELLEVUE AVENUE
BRISTOL CT
06010
US

IV. Provider business mailing address

61 BELLEVUE AVENUE
BRISTOL CT
06010
US

V. Phone/Fax

Practice location:
  • Phone: 860-289-2180
  • Fax: 860-289-4438
Mailing address:
  • Phone: 860-289-2180
  • Fax: 860-289-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BARRY BOKOW
Title or Position: DIRECTOR OF ACCOUNTS RECEIVABLES
Credential:
Phone: 516-705-4800