1295764082 NPI number — CPL (MEADOW VIEW) LLC

Table of Contents

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:
Provider Other Organization Name Type Code:
6
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".




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