Healthcare Provider Details

I. General information

NPI: 1730137753
Provider Name (Legal Business Name): GAYLORD HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GAYLORD FARM RD
WALLINGFORD CT
06492-2899
US

IV. Provider business mailing address

PO BOX 400
WALLINGFORD CT
06492-7048
US

V. Phone/Fax

Practice location:
  • Phone: 203-284-2800
  • Fax: 203-294-3294
Mailing address:
  • Phone: 203-284-2800
  • Fax: 203-294-3294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL IVY
Title or Position: CMO
Credential: MD
Phone: 203-284-2800