NPIMap

Organization Active NPI

Manchester Memorial Hospital, Inc.

  • Psychiatric Hospital Unit
  • Manchester, CT
National Provider Identifier
1295695039
Registry record updated Apr 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
MANCHESTER MEMORIAL HOSPITAL, INC.
Practice address
71 Haynes St
Manchester, CT 06040-4188
Phone
(860) 646-1222
NPI assigned
Nov 14, 2025
Last updated
Apr 20, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gerald Boisvert
Title
Sr Vice President
Phone
(860) 263-4190

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X
Clinical Social Worker 1041C0700X
Psychiatry Physician 2084P0800X
Addiction Psychiatry Physician 2084P0802X
Child & Adolescent Psychiatry Physician 2084P0804X
Geriatric Psychiatry Physician 2084P0805X

Addresses

Primary practice location

71 Haynes St
Manchester, CT 06040-4188

Mailing address

1290 Silas Deane Hwy Ste 102
Wethersfield, CT 06109-4337
Phone (860) 972-3075

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20251203001016 CT Part A Provider - Hospital 1658864202 Practice locations: Manchester, CT; Vernon, CT
O20260422002111 CT Part B Supplier - Clinic/Group Practice 1658864202 Receives reassigned benefits from 53 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Manchester, CT; South Windsor, CT; Vernon, CT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295695039. Details of each certification follow.

Hospital certification: CCN 07S027

Legal name
MANCHESTER MEMORIAL HOSPITAL, INC.
Doing business as
MANCHESTER MEMORIAL HOSPITAL
Organization structure
LLCNon-profit
Enrollment address
71 Haynes St
Manchester, CT 60404131
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Manchester Memorial Hospital Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gerald Boisvert Individual Corporate OfficerAo/Sr VP of Financial Operations Jan 1, 2026
W-2 Managing EmployeeAo/Sr VP of Financial Operations Jan 1, 2026
Sheryl Ann Decilio Individual W-2 Managing EmployeeHHC VP Finance Manchester Jan 1, 2026
Adam Steinberg Individual Corporate OfficerPresident of Hospital Jan 1, 2026
Chibueze Agba Individual Corporate DirectorDirector Jan 1, 2026
Hartford Healthcare Corporation Organization, Hartford, CT 5% Or Greater Direct Ownership Interest Jan 1, 2026 100%
Karen Goyette Individual Corporate DirectorDirector Jan 1, 2026
Jeffrey Flaks Individual Corporate OfficerPresident and Chief Executive of Jan 1, 2026
David Mack Individual Corporate DirectorDirector Jan 1, 2026

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 17

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1763078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776643200000",
    "number": "1295695039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 SILAS DEANE HWY STE 102",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061094337",
            "telephone_number": "860-972-3075",
            "fax_number": "860-972-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 HAYNES ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404188",
            "telephone_number": "860-646-1222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANCHESTER MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-14",
        "last_updated": "2026-04-20",
        "certification_date": "2026-04-20",
        "status": "A",
        "authorized_official_last_name": "BOISVERT",
        "authorized_official_first_name": "GERALD",
        "authorized_official_title_or_position": "SR VICE PRESIDENT",
        "authorized_official_telephone_number": "860-263-4190"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.