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General NPI Number Information
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NPI Number | 1730137753
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Entity Type | Organization
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Legal Business Name | GAYLORD HOSPITAL, INC.
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 50 GAYLORD FARM RD
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City | WALLINGFORD
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State | CT
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Zip | 06492-2899
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Country | US
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Telephone | 203-284-2800
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Fax | 203-294-3294
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Provider Business Mailing Address
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Address Line | PO BOX 400
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City | WALLINGFORD
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State | CT
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Zip | 06492-7048
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Country | US
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Telephone | 203-284-2800
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Fax | 203-294-3294
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Authorized Official
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Title or Position | CMO
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Name | MICHAEL IVY
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Credential | MD
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Telephone | 203-284-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number |
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License Number State |
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