MEDICARE: BARRE GARDENS NURSING AND REHAB LLC

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
1	314000000X	Skilled Nursing Facility	0270000189	VT
2	314000000X	Skilled Nursing Facility		VT

Other Identifiers

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

General Provider Information

NPI Number	:	1831180116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARRE GARDENS NURSING AND REHAB LLC

Provider Business Mailing Address
First Line	:	99 W HAWTHORNE AVENUE
Second Line	:	SUITE 508
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-6101
Country	:	US
Telephone Number	:	516-505-0000
Fax Number	:	646-943-5896

Provider Business Practice Location Address
First Line	:	378 PROSPECT STREET
Second Line	:
City	:	BARRE
State	:	VT
Zip	:	05641-5421
Country	:	US
Telephone Number	:	802-476-4166
Fax Number	:	802-479-5679

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. AKIVA GLATZER
Credential	:
Telephone Number	:	516-505-0000

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	03/08/2017

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