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General NPI Number Information
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NPI Number | 1144695461
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Entity Type | Organization
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Legal Business Name | WHITE ROSE HOME HEALTHCARE AGENCY
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Dates
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Enumeration Date | 12/11/2015
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Last Update Date | 12/11/2015
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Provider Practice Location Address
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Address Line | 1000 LAFAYETTE BLVD SUITE 1100
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City | BRIDGEPORT
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State | CT
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Zip | 06604-4725
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Country | US
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Telephone | 203-683-6055
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Fax | 203-683-5901
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Provider Business Mailing Address
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Address Line | 1000 LAFAYETTE BLVD SUITE 1100
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City | BRIDGEPORT
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State | CT
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Zip | 06604-4725
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Country | US
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Telephone | 203-683-6055
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Fax | 203-683-5901
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | JODYANN N PRENDERGAST
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Credential |
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Telephone | 203-683-6055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0001039
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License Number State | CT
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