Healthcare Provider Details

I. General information

NPI: 1699887737
Provider Name (Legal Business Name): PLYMOUTH VISITING NURSE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 MAIN ST
TERRYVILLE CT
06786-5901
US

IV. Provider business mailing address

244 MAIN ST
TERRYVILLE CT
06786-5901
US

V. Phone/Fax

Practice location:
  • Phone: 860-585-4026
  • Fax: 860-585-4063
Mailing address:
  • Phone: 860-585-4026
  • Fax: 860-585-4063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberC81911
License Number StateCT

VIII. Authorized Official

Name: JUDITH BLANCHET
Title or Position: ADMINISTRATIVE SUPERVISOR
Credential: R.N.
Phone: 860-585-4026