NPIMap

Organization Active NPI

Village Manor Inc Bankruptcy

  • Skilled Nursing Facility
  • Plainfield, CT
National Provider Identifier
1861456840
Registry record updated Jan 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2003-C Issued in CT
Legal business name
VILLAGE MANOR INC BANKRUPTCY
Practice address
16 Windsor Avenue
Plainfield, CT 06374
Phone
(860) 564-4081
Fax
(860) 564-1472
NPI assigned
Apr 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2011

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

Authorized official

Name
Timothy John Coburn
Title
Administrator/Manager
Phone
(860) 564-4081

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2003-C CT Primary

Addresses

Primary practice location

16 Windsor Avenue
Plainfield, CT 06374

Mailing address

16 Windsor Avenue
Plainfield, CT 06374
Phone (860) 564-4081

Other identifiers 2

IdentifierTypeStateIssuer
000020032MedicaidCT
#20032MedicaidCT

Other names 1

  • VILLAGE MANOR INC BANKRUPTCY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Colonial Health Rehab Center of Plainfield LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294876800000",
    "number": "1861456840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 WINDSOR AVENUE",
            "city": "PLAINFIELD",
            "state": "CT",
            "postal_code": "06374",
            "telephone_number": "860-564-4081",
            "fax_number": "860-564-1472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 WINDSOR AVENUE",
            "city": "PLAINFIELD",
            "state": "CT",
            "postal_code": "06374",
            "telephone_number": "860-564-4081",
            "fax_number": "860-564-1472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE MANOR INC BANKRUPTCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-14",
        "last_updated": "2011-01-13",
        "status": "A",
        "authorized_official_last_name": "COBURN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "ADMINISTRATOR/MANAGER",
        "authorized_official_telephone_number": "860-564-4081"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "2003-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000020032",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "#20032",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VILLAGE MANOR INC BANKRUPTCY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plainfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2011; 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.