1831171156 NPI number — VERNON MANOR HEALTH CARE CENTER, LLC

Table of content: (NPI 1831171156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831171156 NPI number — VERNON MANOR HEALTH CARE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERNON MANOR HEALTH CARE CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831171156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
385 W CENTER ST
Provider Second Line Business Mailing Address:
CARRIAGE HOUSE BUSINESS OFFICE
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06040-4738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-647-7828
Provider Business Mailing Address Fax Number:
860-645-0313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 REGAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06066-2824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-671-0385
Provider Business Practice Location Address Fax Number:
860-871-9098
Provider Enumeration Date:
11/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHILLING
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
860-647-7828

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  991-C , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9910 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com