Healthcare Provider Details

I. General information

NPI: 1073529566
Provider Name (Legal Business Name): HARTFORD HEALTHCARE AT HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 SILAS DEANE HWY STE 4B
WETHERSFIELD CT
06109
US

IV. Provider business mailing address

1290 SILAS DEANE HWY SUITE 4B
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-249-4862
  • Fax: 860-493-8598
Mailing address:
  • Phone: 860-249-4862
  • Fax: 860-493-8598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberC81721
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberC81721
License Number StateCT

VIII. Authorized Official

Name: LAURIE ST. JOHN
Title or Position: VP HARTFORD HEALTHCARE AT HOME
Credential: RN, MSN
Phone: 860-878-4848