Provider Demographics
NPI:1861500563
Name:CPL BEY LEA LLC
Entity Type:Organization
Organization Name:CPL BEY LEA LLC
Other - Org Name:BEY LEA VILLAGE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LINTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-686-3233
Mailing Address - Street 1:2029 MORRIS AVE
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6013
Mailing Address - Country:US
Mailing Address - Phone:908-686-3233
Mailing Address - Fax:908-686-3668
Practice Address - Street 1:1351 OLD FREEHOLD RD
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ65C000310400000X
NJ061529314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0079511Medicaid
NJ315264Medicare ID - Type Unspecified