Provider Demographics
NPI:1700810777
Name:HARTFORD HOSPITAL
Entity Type:Organization
Organization Name:HARTFORD HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VINAL
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:860-594-5330
Mailing Address - Street 1:1 JOHN H STEWART DR
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3126
Mailing Address - Country:US
Mailing Address - Phone:860-667-4453
Mailing Address - Fax:860-667-4459
Practice Address - Street 1:1 JOHN H STEWART DR
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3126
Practice Address - Country:US
Practice Address - Phone:860-667-4453
Practice Address - Fax:860-667-4459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARTFORD HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
313M00000X
CT993-C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000091553Medicaid
CT000009936Medicaid
CT000009936Medicaid