Provider Demographics
NPI:1730137753
Name:GAYLORD HOSPITAL, INC.
Entity Type:Organization
Organization Name:GAYLORD HOSPITAL, INC.
Other - Org Name:GAYLORD HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-284-2800
Mailing Address - Street 1:GAYLORD FARM RD.
Mailing Address - Street 2:PO BOX 400
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492
Mailing Address - Country:US
Mailing Address - Phone:203-284-2800
Mailing Address - Fax:203-294-3294
Practice Address - Street 1:GAYLORD FARM RD.
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492
Practice Address - Country:US
Practice Address - Phone:203-284-2800
Practice Address - Fax:203-294-3294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000070029Medicaid
CT004025284Medicaid
CTC00049Medicare ID - Type Unspecified
CT004025284Medicaid