Manchester CT SNF LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

MANCHESTER CT SNF LLC

Practice address

565 Vernon St
Manchester, CT 06042-2409

Phone

(860) 643-5151

NPI assigned

Oct 30, 2018

Organization subpart

No

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

Authorized official

Name

Lawrence G. Santilli

Title

Manager

Phone

(860) 751-3900

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Crestfield Rehabilitation Center & Fenwood Manor Doing business as

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

{
    "created_epoch": "1540857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676592000000",
    "number": "1578030441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 SOUTH RD",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060322556",
            "telephone_number": "860-751-3915",
            "fax_number": "860-751-3905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 VERNON ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060422409",
            "telephone_number": "860-643-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANCHESTER CT SNF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-30",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-17",
        "status": "A",
        "authorized_official_last_name": "SANTILLI",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "860-751-3900"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000010140",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crestfield Rehabilitation Center & Fenwood Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Maltese
• Jennifer Lynn Malto-Brown, MAOM , LICAC
• William J Malwitz
• Michelle Malz
• Faye F Mamaghani, D.M.D.
• Manchester Dental Arts LLC
• Manchester Family Dental LLC
• Manchester Health Center, Inc
• Manchester Health Department
• Manchester Home Care LLC

• Skilled Nursing Facility in Manchester, CT
• Providers in Manchester, CT by specialty
• Skilled Nursing Facility in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.