Healthcare Provider Details

I. General information

NPI: 1881689180
Provider Name (Legal Business Name): BETHEL VISITING NURSE ASSOCIATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 STONY HILL RD
BETHEL CT
06801-3036
US

IV. Provider business mailing address

70 STONY HILL RD
BETHEL CT
06801-3036
US

V. Phone/Fax

Practice location:
  • Phone: 203-792-0864
  • Fax: 203-730-8053
Mailing address:
  • Phone: 203-792-0864
  • Fax: 203-730-8053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberC805410
License Number StateCT

VIII. Authorized Official

Name: MS. JUDITH L MALIN
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 203-792-0864