Healthcare Provider Details

I. General information

NPI: 1053045294
Provider Name (Legal Business Name): VERNON MANOR SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 REGAN RD
VERNON CT
06066-2824
US

IV. Provider business mailing address

180 REGAN RD
VERNON CT
06066-2824
US

V. Phone/Fax

Practice location:
  • Phone: 860-871-0385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: PINCHOS BAK
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 908-783-3110