Athena Meadowbrook, LLC
Organization Active NPI Skilled Nursing Facility · Granby, CT
NPI 1770547473 · NPPES record last updated Feb 15, 2023
Key facts
- NPI
- 1770547473
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 2080C (CT)
- Legal business name
- ATHENA MEADOWBROOK, LLC
- Practice address
- 350 Salmon Brook St
Granby, CT 06035-1842 - Phone
- (860) 653-9888
- Fax
- (860) 653-8938
- NPI assigned
- Apr 12, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- ATHENA HEALTH CARE ASSOCIATES
Authorized official
- Name
- Lawrence G. Santilli
- Title
- Manager
- Phone
- (860) 751-3900
Parent organization (reported in NPPES) 1
Corporate family (same tax ID) 2
Facilities with the same owner 25
Affiliated clinicians 4
-
Gilberto Ramirez, MD
-
Munish K Shastri, M.D.
-
Gagan D. Singh, M.D
-
Gagandeep Singh, MD
Medicare Care Compare: Nursing home
- Listed as
- Civita Care Meadowbrook
- Overall star rating
- ★★★★☆ 4 of 5
- Health inspections
- ★★★★☆ 4 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Nov 20, 1991
- Medicare certification status
- Active
- Certified beds
- 90 · 83.1 residents per day on average
- Chain
- Athena Healthcare Systems
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Skilled nursing facility certification: CCN 075367
- Legal name
- ATHENA MEADOWBROOK LLC
- Doing business as
- MEADOWBROOK OF GRANBY
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 20, 1991
- Last certification
- Jan 23, 2024
- Beds
- 90
- Ownership / control type
- Corporation
- Multi-facility organization
- Athena Healthcare System
- Organization structure
- LLC · Proprietary
- Incorporated
- Jun 7, 2012 in CT
- Enrollment address
- 350 Salmon Brook St
Granby, CT 06035-1842 - Nursing home name
- CIVITA CARE MEADOWBROOK
- Affiliated entity
- ATHENA HEALTHCARE SYSTEMS
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Lawrence E Santilli |
5% Or Greater Direct Ownership Interest | Jun 7, 2012 | 9% |
| Michael E Mosier |
5% Or Greater Direct Ownership Interest | Jun 7, 2012 | 7.33% |
| W-2 Managing Employee |
Jun 6, 1990 | ||
| Athena Health Care Associates, Inc. |
Operational/Managerial Control | Jan 1, 2012 | |
| Valerie Chakalos-Santilli |
5% Or Greater Direct Ownership Interest | Jun 7, 2012 | 6% |
| Lawrence G Santilli |
5% Or Greater Direct Ownership Interest | Dec 31, 2018 | 72.67% |
| Diane Curtis |
5% Or Greater Direct Ownership Interest | Jun 7, 2012 | 5% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130107000044 | CT | Part a Provider - Skilled Nursing Facility | 7416100193 | Practice locations: Granby, CT |
National Provider Directory
- Tax ID family
- Athena Meadowbrook LLC
- Part of
- Athena Health Care Associates Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 2080C | CT | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0020800 | Medicaid | CT |
Other names
- Meadowbrook of Granby
Other providers in Granby, CT
- Thomas Gregory Alwang
- Athena Meadowbrook, LLC
- Athena Meadowbrook, LLC
- Peter Edward Barwick
- BH Meadowbrook LLC
- William Stewart Blomquist
- Dana Bramble
All providers in Granby, 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 Feb 15, 2023. 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.