NPIMap

Organization Active NPI

Athena Meadowbrook, LLC

Doing business as Meadowbrook of Granby

  • Skilled Nursing Facility
  • Granby, CT
National Provider Identifier
1134562812
Registry record updated Apr 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2080C Issued in CT
Legal business name
ATHENA MEADOWBROOK, LLC
Doing business as
Meadowbrook of Granby
Practice address
350 Salmon Brook St
Granby, CT 06035-1842
Phone
(860) 653-9888
Fax
(860) 653-8938
NPI assigned
Apr 11, 2013
Last updated
Apr 11, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
ATHENA HEALTH CARE ASSOCIATESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 11, 2013

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

Authorized official

Name
Michael Moser
Title
Cfo
Phone
(860) 751-3900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2080C CT Primary

Addresses

Primary practice location

350 Salmon Brook St
Granby, CT 06035-1842

Mailing address

350 Salmon Brook St
Granby, CT 06035-1842
Phone (860) 653-9888

Other identifiers 1

IdentifierTypeStateIssuer
000020800MedicaidCT

Other names 1

  • Meadowbrook of Granby Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Athena Meadowbrook LLC3 organizations share this tax ID, including this one
Part of
Athena Health Care Associates Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1365638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365638400000",
    "number": "1134562812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 SALMON BROOK ST",
            "city": "GRANBY",
            "state": "CT",
            "postal_code": "060351842",
            "telephone_number": "860-653-9888",
            "fax_number": "860-653-8938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 SALMON BROOK ST",
            "city": "GRANBY",
            "state": "CT",
            "postal_code": "060351842",
            "telephone_number": "860-653-9888",
            "fax_number": "860-653-8938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHENA MEADOWBROOK, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ATHENA HEALTH CARE ASSOCIATES",
        "enumeration_date": "2013-04-11",
        "last_updated": "2013-04-11",
        "status": "A",
        "authorized_official_last_name": "MOSER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "860-751-3900"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "2080C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000020800",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meadowbrook of Granby",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Granby, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2013; 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.