Healthcare Provider Details

I. General information

NPI: 1316946601
Provider Name (Legal Business Name): ST. JOSEPH'S MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6448 MAIN ST
TRUMBULL CT
06611-2075
US

IV. Provider business mailing address

6448 MAIN ST
TRUMBULL CT
06611-2075
US

V. Phone/Fax

Practice location:
  • Phone: 203-268-6204
  • Fax: 203-268-5271
Mailing address:
  • Phone: 203-268-6204
  • Fax: 203-268-5271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number684
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number1690
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number684
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateCT

VIII. Authorized Official

Name: SR. MICHELLE ANNE REHO
Title or Position: ADMINISTRATOR
Credential:
Phone: 203-268-6204