Healthcare Provider Details

I. General information

NPI: 1598795122
Provider Name (Legal Business Name): SAINT MARY'S HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 FRANKLIN ST
WATERBURY CT
06706-1221
US

IV. Provider business mailing address

56 FRANKLIN ST
WATERBURY CT
06706-1221
US

V. Phone/Fax

Practice location:
  • Phone: 203-709-6000
  • Fax:
Mailing address:
  • Phone: 203-709-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number0055
License Number StateCT

VIII. Authorized Official

Name: JAMES M HARRIS
Title or Position: REGIONAL DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 860-714-4396