Healthcare Provider Details

I. General information

NPI: 1174082325
Provider Name (Legal Business Name): CHICOPEE REHABILITATION AND NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 NEW LOMBARD RD
CHICOPEE MA
01020-4857
US

IV. Provider business mailing address

44 NEW LOMBARD RD
CHICOPEE MA
01020-4857
US

V. Phone/Fax

Practice location:
  • Phone: 718-974-0266
  • 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: PENINA SANIK
Title or Position: ADMIN
Credential:
Phone: 845-709-4910