Basic Information
| Provider Information | |||||||||
| NPI: | 1548269624 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITAL OF SAINT RAPHAEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 CHAPEL ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065114405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037893000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1450 CHAPEL ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065114405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037893000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, PATIENT ACCOUNTING | ||||||||
| AuthorizedOfficialTelephone: | 2037894241 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | N | Hospital Units | Rehabilitation Unit | 273R00000X | N | Hospital Units | Psychiatric Unit | 282N00000X | CT | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 004011342 | 05 | CT | MEDICAID | 004041612 | 05 | CT | MEDICAID | 004024915 | 05 | CT | MEDICAID |