Provider Demographics
NPI:1114918562
Name:CPL (CABOT) LLC
Entity Type:Organization
Organization Name:CPL (CABOT) LLC
Other - Org Name:RENAISSANCE MANOR ON CABOT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCILLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-608-6100
Mailing Address - Street 1:538 PRESTON AVENUE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4851
Mailing Address - Country:US
Mailing Address - Phone:203-608-6100
Mailing Address - Fax:203-639-3574
Practice Address - Street 1:279 CABOT STREET
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-3139
Practice Address - Country:US
Practice Address - Phone:413-536-3435
Practice Address - Fax:413-536-8259
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW JERSEY SUBACUTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-03
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0049314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0928321Medicaid
MA225352Medicare Oscar/Certification
MA0928321Medicaid