Provider Demographics
NPI:1790763126
Name:INTERIM HEALTHCARE OF HARTFORD, INC.
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF HARTFORD, INC.
Other - Org Name:INTERIM HEALTHCARE OF HARTFORD, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PISANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-470-8855
Mailing Address - Street 1:231 FARMINGTON AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1915
Mailing Address - Country:US
Mailing Address - Phone:860-677-0005
Mailing Address - Fax:860-677-2727
Practice Address - Street 1:231 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1915
Practice Address - Country:US
Practice Address - Phone:860-677-0005
Practice Address - Fax:860-606-9713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC853511251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004044830Medicaid