# REVERA (DELAWARE) LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Linden Grove Health Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417959875
- **Authorized official:** CAROLE M SCILLIA (LLC MANAGER)
- **Authorized official phone:** (860) 347-6300

## Contact information

- **Practice address:** 400 29TH STREET NE, PUYALLUP, WA 98372-6774
- **Practice address phone:** (253) 840-4400
- **Practice address fax:** (253) 840-6733
- **Mailing address:** 538 PRESTON AVE, SUITE 270, MERIDEN, CT 06450-4851
- **Mailing address phone:** (203) 608-6100
- **Mailing address fax:** (203) 639-3574

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 1257 | WA | Yes |
| 314000000X | Skilled Nursing Facility | NH1257 | WA | — |

## Other

- **Enumeration date:** 08/15/2005
- **Last updated:** 05/19/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4112579 | — | WA |