Provider Demographics
NPI:1760995344
Name:HARTFORD HOSPITAL D/B/A CEDAR MOUNTAIN COMMONS
Entity Type:Organization
Organization Name:HARTFORD HOSPITAL D/B/A CEDAR MOUNTAIN COMMONS
Other - Org Name:CEDAR MOUNTAIN COMMONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:860-665-7901
Mailing Address - Street 1:3 JOHN H. STEWART DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3166
Mailing Address - Country:US
Mailing Address - Phone:860-665-7901
Mailing Address - Fax:860-665-7905
Practice Address - Street 1:3 JOHN H. STEWART DRIVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3166
Practice Address - Country:US
Practice Address - Phone:860-665-7901
Practice Address - Fax:860-665-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0096310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility