Provider Demographics
NPI:1700133527
Name:CITY OF HARTFORD
Entity Type:Organization
Organization Name:CITY OF HARTFORD
Other - Org Name:HEALTH AND HUMAN SERVICES DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JACKSON-SHAHEED
Authorized Official - Suffix:
Authorized Official - Credentials:MDH
Authorized Official - Phone:860-757-9311
Mailing Address - Street 1:131 COVENTRY ST.
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1548
Mailing Address - Country:US
Mailing Address - Phone:860-757-4846
Mailing Address - Fax:860-722-6826
Practice Address - Street 1:131 COVENTRY ST.
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1548
Practice Address - Country:US
Practice Address - Phone:860-757-4830
Practice Address - Fax:860-722-6826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QC1500X, 261QH0100X
CT0307261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008042506Medicaid
CT008042506Medicaid