Elim Park Baptist Home, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

666C Issued in CT

Legal business name

ELIM PARK BAPTIST HOME, INC.

Practice address

140 Cook Hill Rd
Cheshire, CT 06410-3736

Phone

(203) 272-3547

Fax

(203) 250-6282

NPI assigned

Aug 4, 2005

Organization subpart

No

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

Authorized official

Name

Mr. David Oberg

Title

Vice President of Health Care Serv.

Phone

(203) 272-3547

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Skilled nursing facility certification: CCN 075265

Legal name

ELIM PARK BAPTIST HOME, INC.

Doing business as

MARCUM LLP

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Mar 20, 1976

Last certification

Sep 13, 2024

Beds

90

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Incorporated

Jan 11, 1915 in CT

Enrollment address

140 Cook Hill Rd
Cheshire, CT 06410-3736

Nursing home name

ELIM PARK BAPTIST HOME, INC

Listed as

Elim Park Baptist Home, IncCCN 075265

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

5 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Mar 20, 1976

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9078.7 residents per day on average

Penalties (3 years)

1Fines totaling $8,018

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Adedayo Adetola, M.D.

  • Internal Medicine Physician
  • New Haven, CT
  • NPI 1861498685

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 9

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Adedayo Adetola, M.D.

  • Internal Medicine Physician
  • New Haven, CT
  • NPI 1861498685

  Nursing home

  Care Compare affiliation
• Brian C Cohen, D.O.

  • Internal Medicine Physician
  • Cheshire, CT
  • NPI 1386826790

  Nursing home

  Care Compare affiliation
• Cassandra Marie Muxen, MD

  • Internal Medicine Physician
  • North Haven, CT
  • NPI 1346744513

  Nursing home

  Care Compare affiliation
• Doris U Okwu

  • Family Nurse Practitioner
  • Guilford, CT
  • NPI 1679273338

  Nursing home

  Care Compare affiliation
• Dana Ranani, MD

  • Internal Medicine Physician
  • Hamden, CT
  • NPI 1275546244

  Nursing home

  Care Compare affiliation
• Elizabeth A Tillman, M.D.

  • Internal Medicine Physician
  • West Haven, CT
  • NPI 1326014630

  Nursing home

  Care Compare affiliation
• Christian Daniel Ward, M.D.

  • Internal Medicine Physician
  • Cheshire, CT
  • NPI 1225423924

  Nursing home

  Care Compare affiliation
• Patrick M Welch, APRN

  • Family Nurse Practitioner
  • West Haven, CT
  • NPI 1972355139

  Nursing home

  Care Compare affiliation
• Mohammed Khan Yosufzai, M.D.

  • Internal Medicine Physician
  • West Haven, CT
  • NPI 1508127671

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1123113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962403576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 COOK HILL RD",
            "city": "CHESHIRE",
            "state": "CT",
            "postal_code": "064103736",
            "telephone_number": "203-272-3547",
            "fax_number": "203-250-6282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 COOK HILL RD",
            "city": "CHESHIRE",
            "state": "CT",
            "postal_code": "064103736",
            "telephone_number": "203-272-3547",
            "fax_number": "203-250-6282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIM PARK BAPTIST HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OBERG",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VICE PRESIDENT OF HEALTH CARE SERV.",
        "authorized_official_telephone_number": "203-272-3547",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "666C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Dzilenski, APRN
• Michelle L Ecke Delgrego, SPEECH THERAPIST
• Maya Edelman, SPEECH THERAPIST
• Mallory Edelson, OT
• Amber Edwards, LCSW
• Erica Elliott, OT
• Jason Emery, PSY.D.
• Ophelia Sison Empleo-Frazier, MSN, GNP-BC
• Kelsey Eng, PHYSICAL THERAPIST
• Victoria Anne Hodge Enquist, LCSW

• All providers in Cheshire, CT
• Skilled Nursing Facility in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.