MEDICARE: HEALTH CARE RELIANCE LLC D/B/A ELLIS MANOR

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	2187C	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	:	1447253281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH CARE RELIANCE LLC D/B/A ELLIS MANOR

Provider Business Mailing Address
First Line	:	1157 HIGHLAND AVE
Second Line	:	STE 102
City	:	CHESHIRE
State	:	CT
Zip	:	06410-1600
Country	:	US
Telephone Number	:	203-250-2030
Fax Number	:	203-250-2034

Provider Business Practice Location Address
First Line	:	210 GEORGE ST
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06114-2823
Country	:	US
Telephone Number	:	860-296-9166
Fax Number	:	860-296-8020

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MS. GLADYS HARRISON
Credential	:
Telephone Number	:	203-250-2030

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/07/2008

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