1295770717 NPI number — HEALTH RESOURCES OF GLASTONBURY, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295770717 NPI number — HEALTH RESOURCES OF GLASTONBURY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH RESOURCES OF GLASTONBURY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SALMON BROOK CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295770717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNETT SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19348-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-925-4436
Provider Business Mailing Address Fax Number:
610-925-4351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
72 SALMON BROOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLASTONBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06033-2131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-633-5244
Provider Business Practice Location Address Fax Number:
860-657-2360
Provider Enumeration Date:
06/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DROPESKEY
Authorized Official First Name:
JANE
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPROATE MANAGER
Authorized Official Telephone Number:
610-925-4231

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2041-C , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ANC772 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000020412 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002041200-00 . This is a "ANTHEM MANAGED MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 948549 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 791 . This is a "ANTHEM - COMMERCIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 83681 . This is a "AETNA-HMO" identifier . This identifiers is of the category "OTHER".