Spectrum Healthcare Manchester, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1014-C Issued in CT

Legal business name

SPECTRUM HEALTHCARE MANCHESTER, LLC

Doing business as

Crestfield Rehabilitation Center & Fenwood Manor

Practice address

565 Vernon St
Manchester, CT 06042-2409

Phone

(860) 643-5151

NPI assigned

Jan 14, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Howard William Dickstein, PHD

Title

President and Chief Executive Offic

Phone

(860) 871-5454

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Crestfield Rehabilitation Center & Fenwood Manor Doing business as

Locations

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218067200000",
    "number": "1831375427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "565 VERNON ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060422409",
            "telephone_number": "860-643-5151"
        },
        {
            "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": "SPECTRUM HEALTHCARE MANCHESTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-14",
        "last_updated": "2008-08-07",
        "status": "A",
        "authorized_official_last_name": "DICKSTEIN",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT AND CHIEF EXECUTIVE OFFIC",
        "authorized_official_telephone_number": "860-871-5454",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "1014-C",
            "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"
        }
    ]
}

• Elizabeth Soucy
• Heather Spada, LPC
• Jori Sparry
• Speak Your Mind Speech Therapy LLC
• Jordan Spector, DDS
• Arriyana Je Spence
• SPH3 Enterprise LLC
• SPH3 Enterprise, LLC (Buckland Hills Dental)
• Sph3Enterprise, LLC
• Kenneth N. Spiegelman, M.D.

• 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 Aug 7, 2008; 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.