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General NPI Number Information
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NPI Number | 1700147741
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Entity Type | Organization
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Legal Business Name | RUSHFORD
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 883 PADDOCK AVE
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City | MERIDEN
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State | CT
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Zip | 06450-7044
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Country | US
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Telephone | 203-630-5278
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Fax |
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Provider Business Mailing Address
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Address Line | 145 SPRUCE BANK RD
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City | HAMDEN
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State | CT
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Zip | 06518-2233
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL MANAGER
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Name | DR. CHRISTY JACKSON
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Credential |
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Telephone | 203-630-5245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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