MEDICARE: BETHEL VISITING NURSE ASSOCIATION INC.

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	C805410	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	P09360	OTHER	COMMUNITY HEALTH PLAN
2	004042545	OTHER	CT COMMUNITY CARE
3	653 BV	OTHER	ANTHEM BCBS
4	782135	OTHER	AETNA
5	A785425	OTHER	OXFORD HEALTH PLAN
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	765195	OTHER	CONNECTICARE

General Provider Information

NPI Number	:	1881689180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHEL VISITING NURSE ASSOCIATION INC.

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

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

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. JUDITH L MALIN
Credential	:	RN
Telephone Number	:	203-792-0864

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	06/04/2010

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