Healthcare Provider Details

I. General information

NPI: 1194781328
Provider Name (Legal Business Name): MIDDLESEX HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 MAIN STREET EXT
MIDDLETOWN CT
06457-3849
US

IV. Provider business mailing address

770 SAYBROOK RD
MIDDLETOWN CT
06457-4739
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-5600
  • Fax: 860-358-5723
Mailing address:
  • Phone: 860-358-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number07-7086A
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number07-7086A
License Number StateCT

VIII. Authorized Official

Name: VINNIE CAPECE
Title or Position: CEO
Credential:
Phone: 860-358-6110