Provider Demographics
NPI:1689632788
Name:CHURCH HOME OF HARTFORD, INC.
Entity Type:Organization
Organization Name:CHURCH HOME OF HARTFORD, INC.
Other - Org Name:SEABURY VISITING NURSES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SURRETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:860-243-4022
Mailing Address - Street 1:222 WINTONBURY AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1954
Mailing Address - Country:US
Mailing Address - Phone:860-243-6077
Mailing Address - Fax:860-286-5404
Practice Address - Street 1:200 SEABURY DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2650
Practice Address - Country:US
Practice Address - Phone:860-243-6077
Practice Address - Fax:860-286-5404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC15911251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004204707Medicaid
CT2538382OtherUNITED HEALTH CARE
36AOtherBLUE CROSS BLUE SHIELD
CT1595132OtherAETNA
DC793501OtherCONNECTICARE
CTA4341620OtherOXFORD
CTA4341620OtherOXFORD