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General NPI Number Information
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NPI Number | 1699887737
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Entity Type | Organization
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Legal Business Name | PLYMOUTH VISITING NURSE ASSOCIATION
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 244 MAIN ST
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City | TERRYVILLE
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State | CT
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Zip | 06786-5901
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Country | US
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Telephone | 860-585-4026
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Fax | 860-585-4063
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Provider Business Mailing Address
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Address Line | 244 MAIN ST
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City | TERRYVILLE
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State | CT
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Zip | 06786-5901
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Country | US
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Telephone | 860-585-4026
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Fax | 860-585-4063
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Authorized Official
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Title or Position | ADMINISTRATIVE SUPERVISOR
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Name | JUDITH BLANCHET
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Credential | R.N.
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Telephone | 860-585-4026
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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 | C81911
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License Number State | CT
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