Provider Demographics
NPI: | 1629075734 |
---|---|
Name: | THE CHARLOTTE HUNGERFORD HOSPITAL |
Entity Type: | Organization |
Organization Name: | THE CHARLOTTE HUNGERFORD HOSPITAL |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | SUSAN |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | SCHAPP |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 860-496-6728 |
Mailing Address - Street 1: | 540 LITCHFIELD ST |
Mailing Address - Street 2: | |
Mailing Address - City: | TORRINGTON |
Mailing Address - State: | CT |
Mailing Address - Zip Code: | 06790-6679 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 860-496-6729 |
Mailing Address - Fax: | 860-496-6753 |
Practice Address - Street 1: | 540 LITCHFIELD ST |
Practice Address - Street 2: | |
Practice Address - City: | TORRINGTON |
Practice Address - State: | CT |
Practice Address - Zip Code: | 06790 |
Practice Address - Country: | US |
Practice Address - Phone: | 860-496-6729 |
Practice Address - Fax: | 860-496-6753 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-07-05 |
Last Update Date: | 2021-01-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101YM0800X, 103K00000X, 106H00000X, 207P00000X, 207RC0000X, 208000000X, 2084N0400X, 213E00000X, 231H00000X, 363LA2100X, 363LA2200X, 363LF0000X | ||
CT | 261QM0801X | |
CT | 6609408-000 | 282N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 282N00000X | Hospitals | General Acute Care Hospital | Group - Multi-Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Multi-Specialty |
No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CT | 4025011 | Medicaid | |
CT | 4041711 | Medicaid | |
CT | C00009 | Medicare PIN | |
CT | 4025011 | Medicaid |