1821101486 NPI number — WALNUT HILL, INC.

Table of content: (NPI 1821101486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821101486 NPI number — WALNUT HILL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALNUT HILL, 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:
Provider Other Organization Name Type Code:
6
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:
1821101486
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 GRAND STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRITAIN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-223-3617
Provider Business Mailing Address Fax Number:
860-229-1820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 GRAND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRITAIN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06052-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-223-3617
Provider Business Practice Location Address Fax Number:
860-229-1820
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRIGGS
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
860-223-3617

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1043-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: 797 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 936430 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CU7244 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000010439 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com