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General NPI Number Information
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NPI Number | 1669697983
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Entity Type | Organization
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Legal Business Name | MERCYKNOLL, INC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 243 STEELE RD
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City | WEST HARTFORD
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State | CT
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Zip | 06117-2741
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Country | US
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Telephone | 860-920-6381
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Fax |
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Provider Business Mailing Address
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Address Line | 2021 ALBANY AVE
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City | WEST HARTFORD
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State | CT
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Zip | 06117-2755
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Country | US
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Telephone | 860-920-6381
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Fax |
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Authorized Official
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Title or Position | CONTROLLER
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Name | MS. DEBRA J TREVELIN
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Credential |
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Telephone | 860-920-6381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 784-C
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License Number State | CT
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