Provider Demographics
NPI:1275542219
Name:EASTERN CONNECTICUT REHABILITATION CENTERS
Entity Type:Organization
Organization Name:EASTERN CONNECTICUT REHABILITATION CENTERS
Other - Org Name:ECRC PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HACHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-376-2564
Mailing Address - Street 1:2B LEE RD
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:CT
Mailing Address - Zip Code:06351-3042
Mailing Address - Country:US
Mailing Address - Phone:860-376-2564
Mailing Address - Fax:860-376-4812
Practice Address - Street 1:2 B LEE ROAD
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:CT
Practice Address - Zip Code:06351
Practice Address - Country:US
Practice Address - Phone:860-376-2564
Practice Address - Fax:860-376-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004189024Medicaid
CT703332OtherCONNECTICARE
CT14103OtherORTHNET CIGNA
CT523414GOtherHEALTHY CT
CTA2752221OtherOXFORD
CTOV3122OtherHEALTHNET
CTOV3122OtherHEALTHNET
CTOV3122OtherHEALTHNET