Healthcare Provider Details

I. General information

NPI: 1912301995
Provider Name (Legal Business Name): CROMWELL OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 MAIN ST
CROMWELL CT
06416-2308
US

IV. Provider business mailing address

4260 ROUTE 9
HOWELL NJ
07731-3351
US

V. Phone/Fax

Practice location:
  • Phone: 860-635-5613
  • Fax:
Mailing address:
  • Phone: 732-358-6883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2341
License Number StateCT

VIII. Authorized Official

Name: MR. ARYEH STERN
Title or Position: MEMBER
Credential:
Phone: 732-358-6883