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General NPI Number Information
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NPI Number | 1265880413
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Entity Type | Organization
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Legal Business Name | PROSPECT WATERBURY HOME HEALTH, INC.
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Dates
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Enumeration Date | 05/27/2016
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 365 MAIN ST STE 3A
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City | WATERTOWN
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State | CT
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Zip | 06795-2249
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Country | US
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Telephone | 860-274-7531
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Fax |
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Provider Business Mailing Address
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Address Line | 365 MAIN ST STE 3A
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City | WATERTOWN
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State | CT
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Zip | 06795-2249
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Country | US
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Telephone | 860-274-7531
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Fax | 866-216-7976
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Authorized Official
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Title or Position | SECRETARY
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Name | ROBERT JON ELDERS
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Credential |
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Telephone | 714-788-1249
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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 |
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License Number State |
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