Mercyknoll, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

784-C Issued in CT

Legal business name

MERCYKNOLL, INC

Practice address

243 Steele Rd
West Hartford, CT 06117-2741

Phone

(860) 920-6381

NPI assigned

Apr 13, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Debra J Trevelin

Title

Controller

Phone

(860) 920-6381

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669697983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 ALBANY AVE",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061172755",
            "telephone_number": "860-920-6381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243 STEELE RD",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061172741",
            "telephone_number": "860-920-6381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCYKNOLL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TREVELIN",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "860-920-6381",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "784-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "784-C",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Skilled Nursing Facility in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.