1275562043 NPI number — CPL (BEY LEA VILLAGE) LLC

Table of content: (NPI 1275562043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275562043 NPI number — CPL (BEY LEA VILLAGE) LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CPL (BEY LEA VILLAGE) 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:
BEY LEA VILLAGE NURSING AND REHABILITATION 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:
1275562043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2011
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:
1351 OLD FREEHOLD ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08753-2775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-240-0090
Provider Business Practice Location Address Fax Number:
732-244-8551
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:
203-608-6100

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  65C000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 061529 , 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: 4494903 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0079511 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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