Healthcare Provider Details

I. General information

NPI: 1073637724
Provider Name (Legal Business Name): GREENWICH HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 WEST MAIN STREET
STANFORD CT
06907
US

IV. Provider business mailing address

5 PERRYRIDGE ROAD FINANCE DEPARTMENT
GREENWICH CT
06830-4697
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-3883
  • Fax:
Mailing address:
  • Phone: 203-863-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberC831139H
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberC831139H
License Number StateCT

VIII. Authorized Official

Name: EUGENE COLUCCI
Title or Position: V.P./CFO
Credential:
Phone: 203-863-3008