Provider Demographics
NPI:1629076542
Name:162 SOUTH BRITAIN ROAD OPERATING COMPANY II, LLC
Entity Type:Organization
Organization Name:162 SOUTH BRITAIN ROAD OPERATING COMPANY II, LLC
Other - Org Name:RIVER GLEN HEALTH CARE CENTER.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, SPECIAL PROJECTS
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-930-6051
Mailing Address - Street 1:162 SOUTH BRITAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488
Mailing Address - Country:US
Mailing Address - Phone:203-264-9600
Mailing Address - Fax:203-264-9603
Practice Address - Street 1:162 SOUTH BRITAIN ROAD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488
Practice Address - Country:US
Practice Address - Phone:203-264-9600
Practice Address - Fax:203-264-9603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2280314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000009431Medicaid
DE000009431Medicaid