Provider Demographics
NPI:1174749329
Name:HARTFORD HEALTHCARE REHABILITATION NETWORK
Entity type:Organization
Organization Name:HARTFORD HEALTHCARE REHABILITATION NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-696-2550
Mailing Address - Street 1:181 PATRICIA M GENOVA DR
Mailing Address - Street 2:SUITE A200
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-1500
Mailing Address - Country:US
Mailing Address - Phone:860-696-2550
Mailing Address - Fax:860-696-2525
Practice Address - Street 1:181 PATRICIA M GENOVA DR
Practice Address - Street 2:SUITE A200
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-1500
Practice Address - Country:US
Practice Address - Phone:860-696-2550
Practice Address - Fax:860-696-2525
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARTFORD HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT235Z00000X, 225X00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004212362Medicaid
CT004212362Medicaid