Healthcare Provider Details

I. General information

NPI: 1053480293
Provider Name (Legal Business Name): JOHNSON MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CHESTNUT HILL RD
STAFFORD SPRINGS CT
06076-4005
US

IV. Provider business mailing address

201 CHESTNUT HILL RD
STAFFORD SPRINGS CT
06076-4005
US

V. Phone/Fax

Practice location:
  • Phone: 860-684-4251
  • Fax:
Mailing address:
  • Phone: 860-684-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0072
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0072
License Number StateCT

VIII. Authorized Official

Name: ANTONIO PERUGION
Title or Position: VICE PRESIDENT AND REGIONAL CFO
Credential:
Phone: 860-714-4714