1295764082 NPI number — CPL (MEADOW VIEW) LLC

Table of content: (NPI 1295764082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295764082 NPI number — CPL (MEADOW VIEW) LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CPL (MEADOW VIEW) LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEADOW VIEW NURSING & RESPIRATORY CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295764082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
538 PRESTON AVENUE
Provider Second Line Business Mailing Address:
SUITE 270
Provider Business Mailing Address City Name:
MERIDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06450-4851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-608-6100
Provider Business Mailing Address Fax Number:
203-639-3574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1420 SOUTH BLACK HORSE PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08094-9130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-875-0100
Provider Business Practice Location Address Fax Number:
856-629-4619
Provider Enumeration Date:
07/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCILLIA
Authorized Official First Name:
CAROLE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
LLC MANAGER
Authorized Official Telephone Number:
203-608-6134

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  060808 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4478002 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4478606 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".