Provider Demographics
NPI:1316153299
Name:BRISTOL CROSSINGS LLC
Entity type:Organization
Organization Name:BRISTOL CROSSINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTS RECEIVABLES
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-705-4800
Mailing Address - Street 1:61 BELLEVUE AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010
Mailing Address - Country:US
Mailing Address - Phone:860-289-2180
Mailing Address - Fax:860-289-4438
Practice Address - Street 1:61 BELLEVUE AVENUE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:860-289-2180
Practice Address - Fax:860-289-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000009043Medicaid
CT000009043Medicaid