1952310971 NPI number — EASTERN CONNECTICUT REHABILITATION CENTERS

Table of content: MR. TIMOTHY DAVID GYSIN MFT (NPI 1043341274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952310971 NPI number — EASTERN CONNECTICUT REHABILITATION CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN CONNECTICUT REHABILITATION CENTERS
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:
1952310971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 425
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYVILLE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06241-0425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-376-2564
Provider Business Mailing Address Fax Number:
860-376-4812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 HARTFORD PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KILLINGLY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06241-1556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-376-2564
Provider Business Practice Location Address Fax Number:
860-376-4812
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HACHEY
Authorized Official First Name:
KRISTI
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
VP OF OPERATIONS
Authorized Official Telephone Number:
860-376-2564

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , 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: 523414G . This is a "HEALTHY CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 703332 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 14102 . This is a "ORTHNET CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004189024 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: A2752221 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: OV3123 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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