Provider Demographics
NPI:1073573317
Name:BRISTOL CCH GROUP, LLC
Entity Type:Organization
Organization Name:BRISTOL CCH GROUP, LLC
Other - Org Name:ATHENA HEALTH CARE SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANTILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-751-3900
Mailing Address - Street 1:1660 STAFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-2571
Mailing Address - Country:US
Mailing Address - Phone:860-583-8483
Mailing Address - Fax:860-585-7913
Practice Address - Street 1:1660 STAFFORD AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-2571
Practice Address - Country:US
Practice Address - Phone:860-583-8483
Practice Address - Fax:860-585-7913
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENA HEALTH CARE ASSOCIATES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-23
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2285314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000021303Medicaid
CT000021303Medicaid