Provider Demographics
NPI:1881716686
Name:CPL (SOUTH COUNTY) LLC
Entity type:Organization
Organization Name:CPL (SOUTH COUNTY) LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LLC MANAGER
Authorized Official - Prefix:
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 PRESTON 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 1:740 OAK HILL ROAD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-7205
Practice Address - Country:US
Practice Address - Phone:401-294-4545
Practice Address - Fax:401-295-7650
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW JERSEY CPL HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-04
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILTC00678314000000X
RILTC00746314000000X
RILTS00746314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI401028OtherRI BLUE CHIP
RI4105071Medicaid
RICP66176Medicaid
RI7100217OtherUNITED HEALTH CARE
RI5044-3OtherBC & BS OF RI
RI415071Medicare Oscar/Certification
415071Medicare Oscar/Certification