Organization
CPL (GLEN RIDGE) LLC
Active
Parent organization
NEW JERSEY SUBACUTE LLC
Other names
Glen Ridge Nursing Care Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
NEW JERSEY SUBACUTE LLC
Authorized official
MR. CAROLE M SCILLIA (LLC MANAGER)
(203) 608-6100
Entity
Organization
Contact information
Practice address
120 MURRAY STREET, MEDFORD, MA 02155-1300
(781) 391-0800
(781) 391-9127
Mailing address
538 PRESONT AVENUE, SUITE 270, MERIDEN, CT 06450-4851
(203) 608-6100
(203) 639-3574
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0919
MA
314000000X
Skilled Nursing Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0940054
—
MA
01
—
22225523
BLUE CROSS BLUE SHIELD
MA
01
—
7100014
EVERCARE
MA
01
—
907769
HARVARD PILGRIM
MA
01
—
982256
TUFTS HMO
MA
Enumeration date
09/29/2005
Last updated
07/27/2011
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