Provider Demographics
NPI:1982180287
Name:LCS ESSEX MEADOWS LLC
Entity Type:Organization
Organization Name:LCS ESSEX MEADOWS LLC
Other - Org Name:ESSEX MEADOWS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRIDGEWATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-875-4500
Mailing Address - Street 1:30 BOKUM RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1510
Mailing Address - Country:US
Mailing Address - Phone:860-767-7201
Mailing Address - Fax:860-767-0014
Practice Address - Street 1:30 BOKUM RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1510
Practice Address - Country:US
Practice Address - Phone:860-767-7201
Practice Address - Fax:860-767-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility