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NPI Code Detail

MEDICARE: JEWISH HOME FOR THE ELDERLY OF FAIRFIELD COUNTY INCORPORATED

MEDICARE: JEWISH HOME FOR THE ELDERLY OF FAIRFIELD COUNTY INCORPORATED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility923-CCT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083602346
Entity Type Code : Organization
Provider Name (Legal Business Name) : JEWISH HOME FOR THE ELDERLY OF FAIRFIELD COUNTY INCORPORATED
Provider Business Mailing Address
First Line : 4200 PARK AVE
Second Line :
City : BRIDGEPORT
State : CT
Zip : 06604-1049
Country : US
Telephone Number : 203-365-6400
Fax Number : 203-396-1108
Provider Business Practice Location Address
First Line : 4200 PARK AVE
Second Line :
City : BRIDGEPORT
State : CT
Zip : 06604-1049
Country : US
Telephone Number : 203-365-6400
Fax Number : 203-396-1108
Authorized Official
Title or Position : PRESIDENT/ CEO
Name : MR. ANDREW H. BANOFF
Credential :
Telephone Number : 203-365-6400
Provider Enumeration Date : 10/11/2005
Last Update Date : 05/19/2025

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Practice Location Address:
4200 PARK AVE
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06604-1049
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Practice Fax:
1194049577 — MRS. MAXINE WALSH
Practice Location Address:
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06604-1049
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Directions to “JEWISH HOME FOR THE ELDERLY OF FAIRFIELD COUNTY INCORPORATED ” Practice Location

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