Healthcare Provider Details

I. General information

NPI: 1326027046
Provider Name (Legal Business Name): LEDYARD REGIONAL VISITING NURSE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 COLONEL LEDYARD HWY
LEDYARD CT
06339-1511
US

IV. Provider business mailing address

741 COLONEL LEDYARD HWY
LEDYARD CT
06339-1511
US

V. Phone/Fax

Practice location:
  • Phone: 860-464-8464
  • Fax: 860-464-7605
Mailing address:
  • Phone: 860-464-8464
  • Fax: 860-464-7605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberC81731
License Number StateCT

VIII. Authorized Official

Name: MRS. KAREN GOETCHIUS
Title or Position: ADMINISTRATIVE SUPERVISOR
Credential: MSN, RN, CHCE
Phone: 860-464-8464