MEDICARE: MOUNT SINAI REHABILITATION HOSPITAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	283X00000X	Rehabilitation Hospital	17CD	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	358444	OTHER	CT	WELLCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	H433125	OTHER	CT	OXFORD

General Provider Information

NPI Number	:	1053357533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT SINAI REHABILITATION HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	114 WOODLAND ST
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-1208
Country	:	US
Telephone Number	:	860-714-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	490 BLUE HILLS AVE
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06112-1513
Country	:	US
Telephone Number	:	860-714-4953
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VALERIE POWELL-STAFFORD
Credential	:
Telephone Number	:	860-714-5387

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	06/11/2025

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