Healthcare Provider Details

I. General information

NPI: 1609890284
Provider Name (Legal Business Name): HARTFORD HEALTHCARE INDEPENDENCE AT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 SILAS DEANE HWY
WETHERSFIELD CT
06109-4337
US

IV. Provider business mailing address

1290 SILAS DEANE HWY
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-249-4862
  • Fax: 860-493-5988
Mailing address:
  • Phone: 860-249-4862
  • Fax: 860-493-5988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier790049
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerCONNECTICARE
# 2
Identifier253
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerANTHEM BCBS
# 3
Identifier2V5229
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerHEALTH NET
# 4
Identifier004042750
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer
# 5
Identifier253
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerBLU CARE FAMILY PLAN
# 6
IdentifierA471833
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerOXFORD
# 7
Identifier004073268
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerCT COMMUNITY CARE INC
# 8
Identifier004130407
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerCT HONE CARE PROGRAM

VIII. Authorized Official

Name: LAURIE ST. JOHN
Title or Position: VICE PRESIDENT
Credential: RN, MSN
Phone: 860-878-4848