MEDICARE: PORTLAND CARE AND REHABILITATION CENTRE

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
1	314000000X	Skilled Nursing Facility	871-C	CT

General Provider Information

NPI Number	:	1003947177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTLAND CARE AND REHABILITATION CENTRE

Provider Business Mailing Address
First Line	:	333 MAIN ST
Second Line	:
City	:	PORTLAND
State	:	CT
Zip	:	06480-1561
Country	:	US
Telephone Number	:	860-342-0370
Fax Number	:	860-342-3020

Provider Business Practice Location Address
First Line	:	333 MAIN ST
Second Line	:
City	:	PORTLAND
State	:	CT
Zip	:	06480-1561
Country	:	US
Telephone Number	:	860-342-0370
Fax Number	:	860-342-3020

Authorized Official
Title or Position	:	COO
Name	:	MR. GERALD YUSKA
Credential	:
Telephone Number	:	860-342-0370

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/18/2007

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Directions to “PORTLAND CARE AND REHABILITATION CENTRE ” Practice Location

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