Provider Demographics
NPI:1831185883
Name:CHESHIRE HOUSE LLC
Entity type:Organization
Organization Name:CHESHIRE HOUSE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SBRIGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NHA, CEO
Authorized Official - Phone:203-381-1327
Mailing Address - Street 1:3396 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3812
Mailing Address - Country:US
Mailing Address - Phone:203-754-2161
Mailing Address - Fax:203-756-2293
Practice Address - Street 1:3396 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3812
Practice Address - Country:US
Practice Address - Phone:203-754-2161
Practice Address - Fax:203-756-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2141C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTA1298909OtherOXFORD - HMO CARRIER
CT000006577Medicaid
CT647OtherANTHEM BC/BS CT
CT0831560001OtherNSC - DMERC
CTA1298909OtherOXFORD - HMO CARRIER