Provider Demographics
NPI:1760479349
Name:CPL (GLEN RIDGE) LLC
Entity Type:Organization
Organization Name:CPL (GLEN RIDGE) LLC
Other - Org Name:GLEN RIDGE NURSING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC MANAGER
Authorized Official - Prefix:MR
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 PRESONT 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 1:120 MURRAY STREET
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1300
Practice Address - Country:US
Practice Address - Phone:781-391-0800
Practice Address - Fax:781-391-9127
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW JERSEY SUBACUTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-29
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
MA0919314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22225523OtherBLUE CROSS BLUE SHIELD
MA907769OtherHARVARD PILGRIM
MA982256OtherTUFTS HMO
MA7100014OtherEVERCARE
MA0940054Medicaid
225523Medicare Oscar/Certification
MA982256OtherTUFTS HMO