Provider Demographics
NPI:1831171156
Name:VERNON MANOR HEALTH CARE CENTER, LLC
Entity type:Organization
Organization Name:VERNON MANOR HEALTH CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHILLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-647-7828
Mailing Address - Street 1:385 W CENTER ST
Mailing Address - Street 2:CARRIAGE HOUSE BUSINESS OFFICE
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4738
Mailing Address - Country:US
Mailing Address - Phone:860-647-7828
Mailing Address - Fax:860-645-0313
Practice Address - Street 1:180 REGAN RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-2824
Practice Address - Country:US
Practice Address - Phone:860-671-0385
Practice Address - Fax:860-871-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT991-C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT9910Medicaid
075334Medicare ID - Type Unspecified