Provider Demographics
NPI:1417952631
Name:301 ROPE FERRY ROAD, LLC
Entity Type:Organization
Organization Name:301 ROPE FERRY ROAD, LLC
Other - Org Name:BAYVIEW HEALTH CARE
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 1:301 ROPE FERRY RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2610
Mailing Address - Country:US
Mailing Address - Phone:860-444-1175
Mailing Address - Fax:860-437-2173
Practice Address - Street 1:301 ROPE FERRY RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2610
Practice Address - Country:US
Practice Address - Phone:860-444-1175
Practice Address - Fax:860-437-2173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENA HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-15
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2318313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000020503Medicaid
CT000095150Medicaid
CT=========OtherFEDERAL TAX ID#
CT000095150Medicaid