Healthcare Provider Details

I. General information

NPI: 1487001715
Provider Name (Legal Business Name): PROSPECT ECHN HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 KEYNOTE DR
VERNON CT
06066-5040
US

IV. Provider business mailing address

8 KEYNOTE DR
VERNON CT
06066-5040
US

V. Phone/Fax

Practice location:
  • Phone: 860-872-9163
  • Fax: 860-872-3030
Mailing address:
  • Phone: 860-872-9163
  • Fax: 860-872-3030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: ROBERT JON ELDERS
Title or Position: SECRETARY
Credential:
Phone: 714-788-1249