Provider Demographics
NPI:1275541005
Name:RUSHFORD CENTER, INC.
Entity Type:Organization
Organization Name:RUSHFORD CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:W
Authorized Official - Last Name:CZERNIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-238-6880
Mailing Address - Street 1:883 PADDOCK AVENUE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450
Mailing Address - Country:US
Mailing Address - Phone:203-238-6881
Mailing Address - Fax:203-634-7040
Practice Address - Street 1:883 PADDOCK AVENUE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450
Practice Address - Country:US
Practice Address - Phone:203-630-5220
Practice Address - Fax:203-634-7083
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARTFORD HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-04
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TB0200X, 103TC0700X, 1041C0700X, 2084P0800X
CT261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004241212Medicaid
CT004259033Medicaid
CT004260551Medicaid
CT004257590Medicaid
CT004262250Medicaid
CT004246030Medicaid
CT004246030Medicaid
CT004241212Medicaid
CT074609Medicare ID - Type Unspecified