Organization Active NPI

Cedar Lane Rehabilitation and Health Care Center LLC

  • Skilled Nursing Facility
  • Waterbury, CT
National Provider Identifier
1104819580
Registry record updated Aug 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2225-C Issued in CT
Legal business name
CEDAR LANE REHABILITATION AND HEALTH CARE CENTER LLC
Practice address
128 Cedar Avenue
Waterbury, CT 06705-2700
Phone
(203) 757-9271
Fax
(203) 757-2988
NPI assigned
Aug 31, 2005
Organization subpart
Yes
Parent organization
CONNECTICUT SUBACUTE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 25, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Carole M. Scillia
Title
LLC Manager
Phone
(203) 608-6100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2225-C CT Primary

Addresses

Primary practice location

128 Cedar Avenue
Waterbury, CT 06705-2700

Mailing address

538 Preston Ave
Suite 270
Meriden, CT 06450-4851
Phone (203) 608-6100

Other identifiers 1

IdentifierTypeStateIssuer
000020156MedicaidCT

Other names 1

  • Village Green of Waterbury Rehabilitation and Health Center Doing business as

National Provider Directory

National Provider Directory

Locations

128 Cedar Ave
Waterbury, CT 06705
Phone (203) 757-9271

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408924800000",
    "number": "1104819580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 PRESTON AVE",
            "address_2": "SUITE 270",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064504851",
            "telephone_number": "203-608-6100",
            "fax_number": "203-639-3574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 CEDAR AVENUE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067052700",
            "telephone_number": "203-757-9271",
            "fax_number": "203-757-2988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR LANE REHABILITATION AND HEALTH CARE CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONNECTICUT SUBACUTE LLC",
        "enumeration_date": "2005-08-31",
        "last_updated": "2014-08-25",
        "status": "A",
        "authorized_official_last_name": "SCILLIA",
        "authorized_official_first_name": "CAROLE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "LLC MANAGER",
        "authorized_official_telephone_number": "203-608-6100",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "2225-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000020156",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Village Green of Waterbury Rehabilitation and Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.