Healthcare Provider Details

I. General information

NPI: 1447253281
Provider Name (Legal Business Name): HEALTH CARE RELIANCE LLC D/B/A ELLIS MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 GEORGE ST
HARTFORD CT
06114-2823
US

IV. Provider business mailing address

1157 HIGHLAND AVE STE 102
CHESHIRE CT
06410-1600
US

V. Phone/Fax

Practice location:
  • Phone: 860-296-9166
  • Fax: 860-296-8020
Mailing address:
  • Phone: 203-250-2030
  • Fax: 203-250-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2187C
License Number StateCT

VIII. Authorized Official

Name: MS. GLADYS HARRISON
Title or Position: CONTROLLER
Credential:
Phone: 203-250-2030