Cook Willow Convalescent Hospital, Inc.
Organization Active NPI Skilled Nursing Facility · Plymouth, CT
NPI 1205979457 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1205979457
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 932-C (CT)
- Legal business name
- COOK WILLOW CONVALESCENT HOSPITAL, INC.
- Practice address
- 81 Hillside Ave
Plymouth, CT 06782-2305 - Phone
- (860) 283-8208
- Fax
- (860) 283-6667
- NPI assigned
- Feb 15, 2007
- Organization subpart
- No
Authorized official
- Name
- Ms. Susan A. Macdonald, R.N.
- Title
- Administrator
- Phone
- (860) 283-8208
Owners & managing parties with NPI records 1
-
Jong Gil Oh, MD
Affiliated clinicians 1
-
Jong Gil Oh, MD
Medicare Care Compare: Nursing home
- Listed as
- Cook Willow Health & Rehabilitation Center, Inc.
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★★☆ 4 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Nov 1, 1991
- Medicare certification status
- Active
- Certified beds
- 60 · 50.2 residents per day on average
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 07D0674634 | Cook Willow Convalescent Hospital, Inc | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Skilled nursing facility certification: CCN 075349
- Legal name
- COOK WILLOW CONVALESCENT HOSPITAL INC
- Doing business as
- COOK WILLOW HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 1, 1991
- Last certification
- Feb 6, 2024
- Beds
- 60
- Ownership / control type
- Corporation
- Organization structure
- Corporation · Proprietary
- Incorporated
- Oct 8, 1974 in CT
- Enrollment address
- 81 Hillside Ave
Plymouth, CT 06782-2305 - Nursing home name
- COOK WILLOW HEALTH & REHABILITATION CENTER, INC.
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Jennesa Le Clair |
Corporate Officer |
Mar 18, 1989 | |
| Operational/Managerial Control | Mar 18, 1989 | ||
| Adp of the SNF | Jan 30, 2004 | ||
| Jong Gil Oh |
Operational/Managerial Control | May 1, 2007 | |
| Adp of the SNF | May 1, 2007 | ||
| Walter Macdonald |
Corporate Officer |
Jan 15, 1990 | |
| Susan Macdonald |
5% Or Greater Direct Ownership Interest |
Jul 1, 1975 | 100% |
| Corporate Officer |
Jul 1, 1975 | 100% | |
| Corporate Director |
Jul 1, 1975 | 100% | |
| Operational/Managerial Control | Jul 1, 1975 | ||
| Adp of the SNF | Jul 1, 1975 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120113000300 | CT | Part a Provider - Skilled Nursing Facility | 7113194283 | Practice locations: Plymouth, CT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 932-C | CT | Yes |
Addresses
Primary practice location
81 Hillside Ave
Plymouth, CT 06782-2305
Mailing address
81 Hillside Ave
Plymouth, CT 06782-2305
Phone (860) 283-8208
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 649 | Other | CT | ANTHEM BCBS |
| IV5659 | Other | CT | HEALTHNET PROVIDER |
| V631P-3901 | Other | CT | VETERAN AFFAIRS CONTRACT |
Other providers in Plymouth, CT
- Natalena Block
- Connecticut Clinical Nursing Associates, LLC
- Cook'S Home Health Center, Inc
- Cook'S Home Health Center, Inc.
- Cook'S Home Health Transportation, LTD.
- CT Socialwork LLC
- Emil Danailov
All providers in Plymouth, CT · Skilled Nursing Facility in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.