NPIMap

Organization Active NPI

Jewish Home for the Elderly of Fairfield County Incorporated

Doing business as Mozaic Outpatient Rehab

  • Rehabilitation Clinic/Center
  • Bridgeport, CT
National Provider Identifier
1285962928
Registry record updated Aug 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
JEWISH HOME FOR THE ELDERLY OF FAIRFIELD COUNTY INCORPORATED
Doing business as
Mozaic Outpatient Rehab
Mozaic Senior Life
Practice address
4200 Park Ave
Bridgeport, CT 06604-1049
Phone
(203) 365-6400
NPI assigned
Nov 18, 2009
Last updated
Aug 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sheila Robinson
Title
Ar Supervisor
Phone
(203) 396-1075

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

4200 Park Ave
Bridgeport, CT 06604-1049

Mailing address

4200 Park Ave
Bridgeport, CT 06604-1049
Phone (203) 365-6400

Other names 2

  • Mozaic Outpatient Rehab Doing business as
  • Mozaic Senior Life Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140610000429 CT Part B Supplier - Clinic/Group Practice 6901706332 Receives reassigned benefits from 19 practitioners
Practice locations: Bridgeport, CT

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
The Jewish Home for the Elderly of Fairfield County Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1 Post Rd
Fl 3
Fairfield, CT 06824
Phone (203) 365-8454

175 Jefferson St
Fairfield, CT 06825
Phone (203) 365-6400

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mozaic Senior LifeBridgeport, CT, CCN 075353 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1973

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1258502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723593600000",
    "number": "1285962928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 PARK AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066041049",
            "telephone_number": "203-365-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 PARK AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066041049",
            "telephone_number": "203-365-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEWISH HOME FOR THE ELDERLY OF FAIRFIELD COUNTY INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-18",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "AR SUPERVISOR",
        "authorized_official_telephone_number": "203-396-1075"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mozaic Outpatient Rehab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mozaic Senior Life",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeport, CT

Sources for this page

Verify at the official NPI Registry.