Healthcare Provider Details

I. General information

NPI: 1831171156
Provider Name (Legal Business Name): VERNON MANOR HEALTH CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 REGAN RD
VERNON CT
06066-2824
US

IV. Provider business mailing address

385 W CENTER ST CARRIAGE HOUSE BUSINESS OFFICE
MANCHESTER CT
06040-4738
US

V. Phone/Fax

Practice location:
  • Phone: 860-671-0385
  • Fax: 860-871-9098
Mailing address:
  • Phone: 860-647-7828
  • Fax: 860-645-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number991-C
License Number StateCT

VIII. Authorized Official

Name: KAREN SCHILLING
Title or Position: CONTROLLER
Credential:
Phone: 860-647-7828