Basic Information
| Provider Information | |||||||||
| NPI: | 1871536227 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCKVILLE GENERAL HOSPITAL, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 UNION ST | ||||||||
| Address2: | |||||||||
| City: | VERNON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060663126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606461222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 31 UNION ST | ||||||||
| Address2: | |||||||||
| City: | VERNON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060663126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606461222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 12/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | KARL | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8606461222 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EASTERN CONNETICUT HEALTH NETWORK INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | 0036 | CT | N | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care | 282N00000X | 0036 | CT | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 4025029 | 05 | CT | MEDICAID | 4041729 | 05 | CT | MEDICAID |