Organization
SPECTRUM HEALTHCARE MANCHESTER, LLC
Active
Other names
Crestfield Rehabilitation Center & Fenwood Manor
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOWARD WILLIAM DICKSTEIN PHD (PRESIDENT AND CHIEF EXECUTIVE OFFIC)
(860) 871-5454
Entity
Organization
Contact information
Practice address
565 VERNON ST, MANCHESTER, CT 06042-2409
(860) 643-5151
Mailing address
565 VERNON ST, MANCHESTER, CT 06042-2409
(860) 643-5151
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1014-C
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000010140
—
CT
Enumeration date
01/14/2008
Last updated
08/07/2008
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