Healthcare Provider Details

I. General information

NPI: 1598703514
Provider Name (Legal Business Name): HBR DANBURY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 LINCOLN AVE
DANBURY CT
06810-7963
US

IV. Provider business mailing address

101 SUN AVE NE COMPLIANCE DIRECTOR
ALBUQUERQUE NM
87109-4373
US

V. Phone/Fax

Practice location:
  • Phone: 203-797-9300
  • Fax: 203-780-4645
Mailing address:
  • Phone: 505-468-5604
  • Fax: 505-468-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1067-C
License Number StateCT

VIII. Authorized Official

Name: MR. MICHAEL T BERG
Title or Position: AUTH OFFICIAL
Credential:
Phone: 505-468-4742