Provider Demographics
NPI:1316946601
Name:ST. JOSEPH'S MANOR
Entity type:Organization
Organization Name:ST. JOSEPH'S MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SR. MICHELLE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:REHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-268-6204
Mailing Address - Street 1:6448 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-2075
Mailing Address - Country:US
Mailing Address - Phone:203-268-6204
Mailing Address - Fax:203-268-5271
Practice Address - Street 1:6448 MAIN ST
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-2075
Practice Address - Country:US
Practice Address - Phone:203-268-6204
Practice Address - Fax:203-268-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT684314000000X, 313M00000X
CT1690313M00000X
CT311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT075001Medicare ID - Type Unspecified