1821089194 NPI number — CPL ILIFF LLC

Table of content: (NPI 1821089194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821089194 NPI number — CPL ILIFF LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CPL ILIFF 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:
ILIFF 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:
1821089194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2011
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:
8000 ILIFF DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNN LORING
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22027-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-560-1000
Provider Business Practice Location Address Fax Number:
703-280-0406
Provider Enumeration Date:
11/04/2005

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: 314000000X , with the licence number:  NH2592 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1821089194 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004960360 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004952057 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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