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

VIII. Authorized Official

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