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General NPI Number Information
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NPI Number | 1669283883
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Entity Type | Organization
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Legal Business Name | BRISTOL SNF OPERATIONS, LLC
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 23 FAIR ST
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City | BRISTOL
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State | CT
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Zip | 06010-5531
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Country | US
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Telephone | 860-589-2923
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Fax |
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Provider Business Mailing Address
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Address Line | 100 BOULEVARD OF AMERICAS
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City | LAKEWOOD
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State | NJ
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Zip | 08701-4585
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | PHIL BAK
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Credential |
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Telephone | 908-783-3110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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