Healthcare Provider Details

I. General information

NPI: 1093173486
Provider Name (Legal Business Name): HAMDEN REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 SHERMAN AVE
HAMDEN CT
06514-1330
US

IV. Provider business mailing address

1270 SHERMAN AVE
HAMDEN CT
06514-1330
US

V. Phone/Fax

Practice location:
  • Phone: 203-281-7555
  • Fax: 203-281-3827
Mailing address:
  • Phone: 203-281-7555
  • Fax: 203-281-3827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000009902
License Number StateCT

VIII. Authorized Official

Name: MORDECHAI BLASS
Title or Position: MANAGING MEMBER
Credential: LNHA
Phone: 203-281-7555