Provider Demographics
NPI:1477793693
Name:NATCHAUG HOSPITAL
Entity Type:Organization
Organization Name:NATCHAUG HOSPITAL
Other - Org Name:JOSHUA CENTER SOUTHEAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARCEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-456-1311
Mailing Address - Street 1:20 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-2345
Mailing Address - Country:US
Mailing Address - Phone:860-848-3098
Mailing Address - Fax:860-848-1152
Practice Address - Street 1:20 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-2345
Practice Address - Country:US
Practice Address - Phone:860-848-3098
Practice Address - Fax:860-848-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE48610283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital