MEDICARE: SAINT RAPHAEL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1174830228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT RAPHAEL HOSPITAL

Provider Business Mailing Address
First Line	:	32 HIGH ST
Second Line	:	APT # 503
City	:	NEW HAVEN
State	:	CT
Zip	:	06510-2314
Country	:	US
Telephone Number	:	507-271-5974
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450, CHAPEL STREET
Second Line	:	HOSPITAL OF SAINT RAPHAEL
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-2204
Country	:	US
Telephone Number	:	203-788-9657
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MISS BARBARA DAHL
Credential	:
Telephone Number	:	203-788-9876

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	09/10/2010

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