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General NPI Number Information
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NPI Number | 1760995344
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Entity Type | Organization
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Legal Business Name | HARTFORD HOSPITAL D/B/A CEDAR MOUNTAIN COMMONS
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Dates
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Enumeration Date | 11/06/2017
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 3 JOHN H. STEWART DRIVE
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City | NEWINGTON
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State | CT
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Zip | 06111-3166
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Country | US
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Telephone | 860-665-7901
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Fax | 860-665-7905
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Provider Business Mailing Address
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Address Line | 3 JOHN H. STEWART DRIVE
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City | NEWINGTON
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State | CT
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Zip | 06111-3166
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Country | US
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Telephone | 860-665-7901
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Fax | 860-665-7905
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JAMES CASEY JR.
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Credential |
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Telephone | 860-665-7901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 0096
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License Number State | CT
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