Healthcare Provider Details

I. General information

NPI: 1336178276
Provider Name (Legal Business Name): STRATFORD VISITING NURSE ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 MAIN ST
STRATFORD CT
06614-4939
US

IV. Provider business mailing address

3060 MAIN ST
STRATFORD CT
06614-4939
US

V. Phone/Fax

Practice location:
  • Phone: 203-375-5871
  • Fax: 203-378-8193
Mailing address:
  • Phone: 203-375-5871
  • Fax: 203-378-8193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberC81841
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberC81841
License Number StateCT

VIII. Authorized Official

Name: MRS. MARY THERIEN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 203-375-5871