Provider Demographics
NPI:1275562043
Name:CPL (BEY LEA VILLAGE) LLC
Entity Type:Organization
Organization Name:CPL (BEY LEA VILLAGE) LLC
Other - Org Name:BEY LEA VILLAGE NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC MANAGER
Authorized Official - Prefix:
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 1:1351 OLD FREEHOLD ROAD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2775
Practice Address - Country:US
Practice Address - Phone:732-240-0090
Practice Address - Fax:732-244-8551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW JERSEY CPL HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-02
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ65C000310400000X
NJ061529314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4494903Medicaid
NJ0079511Medicaid
NJ0079511Medicaid
NJ4494903Medicaid