Provider Demographics
NPI:1003023482
Name:WINDHAM COMMUNITY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:WINDHAM COMMUNITY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-456-6844
Mailing Address - Street 1:112 MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2041
Mailing Address - Country:US
Mailing Address - Phone:860-456-6844
Mailing Address - Fax:860-456-6718
Practice Address - Street 1:123 QUARRY ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-1247
Practice Address - Country:US
Practice Address - Phone:860-465-2620
Practice Address - Fax:860-465-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTOR2915OtherHEALTH NET SCHOOL BASED C
CT96MSBC070CT01OtherBCFP SCHOOL BASED CLINIC
CT=========OtherMANAGED MEDICAID SCHOOL B