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NPI Code Detail

MEDICARE: GROVE MANOR NURSING HOME, INC.

MEDICARE: GROVE MANOR NURSING HOME, INC.
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 Facility494CCT

General Provider Information

NPI Number : 1669474961
Entity Type Code : Organization
Provider Name (Legal Business Name) : GROVE MANOR NURSING HOME, INC.
Provider Business Mailing Address
First Line : 145 GROVE ST
Second Line :
City : WATERBURY
State : CT
Zip : 06710-2202
Country : US
Telephone Number : 203-753-7205
Fax Number : 203-753-6177
Provider Business Practice Location Address
First Line : 145 GROVE ST
Second Line :
City : WATERBURY
State : CT
Zip : 06710-2202
Country : US
Telephone Number : 203-753-7205
Fax Number : 203-753-6177
Authorized Official
Title or Position : ADMINISTRATOR
Name : MS. JANET ALICIENE
Credential :
Telephone Number : 203-753-7205
Provider Enumeration Date : 06/01/2005
Last Update Date : 08/22/2020

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Directions to “GROVE MANOR NURSING HOME, INC. ” Practice Location

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