Provider Demographics
NPI:1073637724
Name:GREENWICH HOSPITAL
Entity Type:Organization
Organization Name:GREENWICH HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P./CFO
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-863-3008
Mailing Address - Street 1:5 PERRYRIDGE ROAD
Mailing Address - Street 2:FINANCE DEPARTMENT
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4697
Mailing Address - Country:US
Mailing Address - Phone:203-863-3000
Mailing Address - Fax:
Practice Address - Street 1:2015 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CT
Practice Address - Zip Code:06907
Practice Address - Country:US
Practice Address - Phone:203-863-3883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENWICH HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC831139H251G00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
071528Medicare Oscar/Certification