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NPI Code Detail

MEDICARE: ATHENA MEADOWBROOK, LLC

MEDICARE: ATHENA MEADOWBROOK, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility2080CCT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770547473
Entity Type Code : Organization
Provider Name (Legal Business Name) : ATHENA MEADOWBROOK, LLC
Provider Business Mailing Address
First Line : 350 SALMON BROOK ST
Second Line :
City : GRANBY
State : CT
Zip : 06035-1842
Country : US
Telephone Number : 860-653-9888
Fax Number : 860-653-8938
Provider Business Practice Location Address
First Line : 350 SALMON BROOK ST
Second Line :
City : GRANBY
State : CT
Zip : 06035-1842
Country : US
Telephone Number : 860-653-9888
Fax Number : 860-653-8938
Authorized Official
Title or Position : MANAGER
Name : LAWRENCE G. SANTILLI
Credential :
Telephone Number : 860-751-3900
Provider Enumeration Date : 04/12/2006
Last Update Date : 02/15/2023

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Directions to “ATHENA MEADOWBROOK, LLC ” Practice Location

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