Healthcare Provider Details

I. General information

NPI: 1417171398
Provider Name (Legal Business Name): HARTFORD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 APACHE ST
HIAWATHA KS
66434-2634
US

IV. Provider business mailing address

PO BOX 232
SABETHA KS
66534-0232
US

V. Phone/Fax

Practice location:
  • Phone: 785-742-3616
  • Fax:
Mailing address:
  • Phone: 785-284-2949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number StateKS

VIII. Authorized Official

Name: BRENDA SHERWOOD
Title or Position: CEO
Credential:
Phone: 785-284-2949