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NPI Code Detail

MEDICARE: CPL (SOUTH COUNTY) LLC

MEDICARE: CPL (SOUTH COUNTY) 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 FacilityLTC00678RI
2314000000XSkilled Nursing FacilityLTC00746RI
3314000000XSkilled Nursing FacilityLTS00746RI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1401028OTHERRIRI BLUE CHIP
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
47100217OTHERRIUNITED HEALTH CARE
55044-3OTHERRIBC & BS OF RI

General Provider Information

NPI Number : 1881716686
Entity Type Code : Organization
Provider Name (Legal Business Name) : CPL (SOUTH COUNTY) LLC
Provider Business Mailing Address
First Line : 538 PRESTON AVENUE
Second Line : SUITE 270
City : MERIDEN
State : CT
Zip : 06450-4851
Country : US
Telephone Number : 203-608-6100
Fax Number : 203-639-3574
Provider Business Practice Location Address
First Line : 740 OAK HILL ROAD
Second Line :
City : NORTH KINGSTOWN
State : RI
Zip : 02852-7205
Country : US
Telephone Number : 401-294-4545
Fax Number : 401-295-7650
Authorized Official
Title or Position : LLC MANAGER
Name : CAROLE M SCILLIA
Credential :
Telephone Number : 203-608-6100
Provider Enumeration Date : 04/04/2007
Last Update Date : 08/15/2011

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Directions to “CPL (SOUTH COUNTY) LLC ” Practice Location

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