Provider Demographics
NPI:1144203720
Name:ESSEX MEADOWS PROPERTIES, INC.
Entity Type:Organization
Organization Name:ESSEX MEADOWS PROPERTIES, INC.
Other - Org Name:ESSEX MEADOWS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIEVE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:515-875-4754
Mailing Address - Street 1:30 BOKUM RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1510
Mailing Address - Country:US
Mailing Address - Phone:860-767-7201
Mailing Address - Fax:860-767-0014
Practice Address - Street 1:30 BOKUM RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426
Practice Address - Country:US
Practice Address - Phone:860-767-7201
Practice Address - Fax:860-767-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2042-C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
075322Medicare Oscar/Certification