Provider Demographics
NPI:1588824502
Name:B-VII NIANTIC LLC
Entity Type:Organization
Organization Name:B-VII NIANTIC LLC
Other - Org Name:CRESCENT POINT AT NIANTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-739-9479
Mailing Address - Street 1:417 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-3144
Mailing Address - Country:US
Mailing Address - Phone:860-739-9479
Mailing Address - Fax:860-739-9489
Practice Address - Street 1:417 MAIN ST
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-3144
Practice Address - Country:US
Practice Address - Phone:860-739-9479
Practice Address - Fax:860-739-9489
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENCHMARK ASSISTED LIVING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0059310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004228856Medicaid