Provider Demographics
NPI:1184639973
Name:THE GRIFFIN HOSPITAL
Entity Type:Organization
Organization Name:THE GRIFFIN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-732-7500
Mailing Address - Street 1:130 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1326
Mailing Address - Country:US
Mailing Address - Phone:203-732-7360
Mailing Address - Fax:203-732-7386
Practice Address - Street 1:130 DIVISION ST
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1326
Practice Address - Country:US
Practice Address - Phone:203-732-7360
Practice Address - Fax:203-732-7386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00342084P0800X, 208D00000X, 261QE0002X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT28MOtherBLUE CROSS MEDICAID
CT0464667OtherCIGNA
CT60054OtherAETNA
CT87726OtherUNITED HEALTHCARE
CTH03255OtherOXFORD
CT4025219Medicaid
CT990352OtherCONNECTICARE
CT028OtherBLUE CROSS MEDICAL
CT28BOtherANTHEM BLUE CROSS PSYCH
CT000991OtherHEALTHNET
CT4041927Medicaid
CTC00008Medicare ID - Type UnspecifiedMEDICARE B (FIRST COAST)
CT990352OtherCONNECTICARE
CTH03255OtherOXFORD