Provider Demographics
NPI:1457642324
Name:INTERIM HEALTHCARE OF HARTFORD, INC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF HARTFORD, INC
Other - Org Name:INTERIM HEALTHCARE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-677-0005
Mailing Address - Street 1:231 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1915
Mailing Address - Country:US
Mailing Address - Phone:860-677-0005
Mailing Address - Fax:
Practice Address - Street 1:231 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1915
Practice Address - Country:US
Practice Address - Phone:860-677-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERIM HEALTHCARE OF HARTFORD, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC853511251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based