Healthcare Provider Details

I. General information

NPI: 1295811321
Provider Name (Legal Business Name): NATCHAUG HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 STORRS ROAD
MANSFIELD CENTER CT
06250-1683
US

IV. Provider business mailing address

189 STORRS ROAD
MANSFIELD CENTER CT
06250-1683
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-1311
  • Fax: 860-450-0165
Mailing address:
  • Phone: 860-456-1311
  • Fax: 860-450-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberH0003
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberH0003
License Number StateCT

VIII. Authorized Official

Name: MR. PAUL V MALONEY
Title or Position: CFO
Credential:
Phone: 860-456-1311