MEDICARE: WOLCOTT HALL NURSING CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	1096-C	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023187291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOLCOTT HALL NURSING CENTER, INC.

Provider Business Mailing Address
First Line	:	215 FOREST ST
Second Line	:
City	:	TORRINGTON
State	:	CT
Zip	:	06790-4947
Country	:	US
Telephone Number	:	860-482-8554
Fax Number	:	860-496-7108

Provider Business Practice Location Address
First Line	:	215 FOREST ST
Second Line	:
City	:	TORRINGTON
State	:	CT
Zip	:	06790-4947
Country	:	US
Telephone Number	:	860-482-8554
Fax Number	:	860-496-7108

Authorized Official
Title or Position	:	CFO
Name	:	MR. MARK HAMBLEY
Credential	:
Telephone Number	:	860-678-9755

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/16/2012

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