MEDICARE: WHITNEY MANOR OPERATING COMPANY LLC

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	2411	CT
2	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447255468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITNEY MANOR OPERATING COMPANY LLC

Provider Business Mailing Address
First Line	:	2798 WHITNEY AVENUE
Second Line	:
City	:	HAMDEN
State	:	CT
Zip	:	06518
Country	:	US
Telephone Number	:	203-288-6230
Fax Number	:	203-230-2501

Provider Business Practice Location Address
First Line	:	2798 WHITNEY AVENUE
Second Line	:
City	:	HAMDEN
State	:	CT
Zip	:	06518
Country	:	US
Telephone Number	:	203-288-6230
Fax Number	:	203-230-2501

Authorized Official
Title or Position	:	OWNER
Name	:	GIORGIO MAYER
Credential	:
Telephone Number	:	929-271-2556

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/15/2019

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Directions to “WHITNEY MANOR OPERATING COMPANY LLC ” Practice Location

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