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NPI Code Detail

MEDICARE: ROCHESTER MANOR LLC

MEDICARE: ROCHESTER MANOR LLC
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
1314000000XSkilled Nursing Facility02647NH

Other Identifiers

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

General Provider Information

NPI Number : 1811985013
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROCHESTER MANOR LLC
Provider Business Mailing Address
First Line : 538 PRESTON AVENUE
Second Line : SUITE 270
City : MERIDEN
State : CT
Zip : 06450-4851
Country : US
Telephone Number : 203-608-6100
Fax Number : 203-639-3574
Provider Business Practice Location Address
First Line : 40 WHITEHALL ROAD
Second Line :
City : ROCHESTER
State : NH
Zip : 03867-3225
Country : US
Telephone Number : 603-332-7711
Fax Number : 603-330-3013
Authorized Official
Title or Position : LLC MANAGER
Name : MS. CAROLE M SCILLIA
Credential :
Telephone Number : 203-608-6100
Provider Enumeration Date : 10/11/2005
Last Update Date : 06/29/2011

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