Healthcare Provider Details

I. General information

NPI: 1932123569
Provider Name (Legal Business Name): JOHNSON MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CHESTNUT HILL ROAD
STAFFORD SPRINGS CT
06076-0860
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 TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0072
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0072
License Number StateCT

VIII. Authorized Official

Name: ROBERT ROOSE
Title or Position: PRESIDENT
Credential:
Phone: 413-748-9335