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General NPI Number Information
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NPI Number | 1215309679
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Entity Type | Organization
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Legal Business Name | WATERBURY GARDENS NURSING AND REHAB LLC
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Dates
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Enumeration Date | 10/26/2015
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 128 CEDAR AVE
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City | WATERBURY
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State | CT
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Zip | 06705-2700
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Country | US
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Telephone | 516-505-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 99 W HAWTHORNE AVE SUITE 508
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City | VALLEY STREAM
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State | NY
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Zip | 11580-6163
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Country | US
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Telephone | 516-505-0000
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Fax |
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Authorized Official
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Title or Position | MEMEBER
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Name | DAVID GAMZEH
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Credential |
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Telephone | 516-505-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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