915 Ella T Grasso Boulevard Operations LLC

Key facts

NPI

1760633366

Entity type

Organization (NPI type 2)

Primary specialty

Skilled Nursing Facility 314000000X

License

2254 (CT)

Legal business name

915 ELLA T GRASSO BOULEVARD OPERATIONS LLC

Practice address

915 Ella T Grasso Blvd
New Haven, CT 06519-5516

Phone

(203) 865-5155

Fax

(203) 865-5799

NPI assigned

Oct 2, 2008

Organization subpart

No

Authorized official

Name

Marcella Wilkinson

Title

Corporate Director

Phone

(610) 925-4045

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

Other names

• University Skilled Nursing and Rehabilitation Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 5, 2009.

{
    "created_epoch": "1222905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244160000000",
    "number": "1760633366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 ELLA T GRASSO BLVD",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065195516",
            "telephone_number": "203-865-5155",
            "fax_number": "203-865-5799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 ELLA T GRASSO BLVD",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065195516",
            "telephone_number": "203-865-5155",
            "fax_number": "203-865-5799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "915 ELLA T GRASSO BOULEVARD OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-02",
        "last_updated": "2009-06-05",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "MARCELLA",
        "authorized_official_title_or_position": "CORPORATE DIRECTOR",
        "authorized_official_telephone_number": "610-925-4045"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "2254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000020496",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University Skilled Nursing and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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