Healthcare Provider Details

I. General information

NPI: 1669283883
Provider Name (Legal Business Name): BRISTOL SNF OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 FAIR ST
BRISTOL CT
06010-5531
US

IV. Provider business mailing address

100 BOULEVARD OF AMERICAS
LAKEWOOD NJ
08701-4585
US

V. Phone/Fax

Practice location:
  • Phone: 860-589-2923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: PHIL BAK
Title or Position: MANAGING PARTNER
Credential:
Phone: 908-783-3110