Healthcare Provider Details

I. General information

NPI: 1215963822
Provider Name (Legal Business Name): FAMILY CARE VISITING NURSE & HOME HEALTH CARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 ORONOQUE LN
STRATFORD CT
06614-1379
US

IV. Provider business mailing address

999 ORONOQUE LN
STRATFORD CT
06614-1379
US

V. Phone/Fax

Practice location:
  • Phone: 203-380-3220
  • Fax: 203-380-3228
Mailing address:
  • Phone: 203-380-3220
  • Fax: 203-380-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number004138774
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number004140430
License Number StateCT

VIII. Authorized Official

Name: MRS. RITA C KRETT
Title or Position: ADMINISTRATOR
Credential: R.N., B.S.N.
Phone: 203-380-3220