MEDICARE: WHITE ROSE HOME HEALTHCARE AGENCY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	0001039	CT

General Provider Information

NPI Number	:	1144695461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE ROSE HOME HEALTHCARE AGENCY

Provider Business Mailing Address
First Line	:	1000 LAFAYETTE BLVD
Second Line	:	SUITE 1100
City	:	BRIDGEPORT
State	:	CT
Zip	:	06604-4725
Country	:	US
Telephone Number	:	203-683-6055
Fax Number	:	203-683-5901

Provider Business Practice Location Address
First Line	:	1000 LAFAYETTE BLVD
Second Line	:	SUITE 1100
City	:	BRIDGEPORT
State	:	CT
Zip	:	06604-4725
Country	:	US
Telephone Number	:	203-683-6055
Fax Number	:	203-683-5901

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	JODYANN N PRENDERGAST
Credential	:
Telephone Number	:	203-683-6055

Provider Enumeration Date	:	12/11/2015
Last Update Date	:	12/11/2015

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