Healthcare Provider Details

I. General information

NPI: 1821089194
Provider Name (Legal Business Name): CPL ILIFF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 ILIFF DRIVE
DUNN LORING VA
22027-1235
US

IV. Provider business mailing address

538 PRESTON AVENUE SUITE 270
MERIDEN CT
06450-4851
US

V. Phone/Fax

Practice location:
  • Phone: 703-560-1000
  • Fax: 703-280-0406
Mailing address:
  • Phone: 203-608-6100
  • Fax: 203-639-3574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2592
License Number StateVA

VIII. Authorized Official

Name: MS. CAROLE M SCILLIA
Title or Position: LLC MANAGER
Credential:
Phone: 203-608-6100