1881689180 NPI number — BETHEL VISITING NURSE ASSOCIATION INC.

Table of content: (NPI 1881689180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881689180 NPI number — BETHEL VISITING NURSE ASSOCIATION INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETHEL VISITING NURSE ASSOCIATION INC.
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:
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:
1881689180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 STONY HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHEL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06801-3036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-792-0864
Provider Business Mailing Address Fax Number:
203-730-8053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 STONY HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHEL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06801-3036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-792-0864
Provider Business Practice Location Address Fax Number:
203-730-8053
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MALIN
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
203-792-0864

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  C805410 , 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: P09360 . This is a "COMMUNITY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004042545 . This is a "CT COMMUNITY CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 653 BV . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 782135 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: A785425 . This is a "OXFORD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004042545 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 765195 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com