=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619219219
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARTFORD HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2013
-----------------------------------------------------
Last Update Date | 03/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 RETREAT ST INSTITUTE OF LIVING,
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-545-7767
-----------------------------------------------------
Fax | 860-545-7797
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 860 PALISADO AVE
-----------------------------------------------------
City | WINDSOR
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-371-4359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE MANAGER
-----------------------------------------------------
Name | KAREN LEE ANDERSON
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 860-545-7767
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number | 004683
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------