Provider Demographics
NPI:1205839065
Name:HEALTH CARE ALLIANCE, INC D/B/A/ BLAIR MANOR
Entity Type:Organization
Organization Name:HEALTH CARE ALLIANCE, INC D/B/A/ BLAIR MANOR
Other - Org Name:BLAIR MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-250-2030
Mailing Address - Street 1:1157 HIGHLAND AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1600
Mailing Address - Country:US
Mailing Address - Phone:203-250-2030
Mailing Address - Fax:203-250-2034
Practice Address - Street 1:612 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4225
Practice Address - Country:US
Practice Address - Phone:860-749-8388
Practice Address - Fax:860-763-4382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2155C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT075056Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER