MEDICARE: PROSPECT WATERBURY HOME HEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1265880413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSPECT WATERBURY HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	365 MAIN ST STE 3A
Second Line	:
City	:	WATERTOWN
State	:	CT
Zip	:	06795-2249
Country	:	US
Telephone Number	:	860-274-7531
Fax Number	:	866-216-7976

Provider Business Practice Location Address
First Line	:	365 MAIN ST STE 3A
Second Line	:
City	:	WATERTOWN
State	:	CT
Zip	:	06795-2249
Country	:	US
Telephone Number	:	860-274-7531
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	ROBERT JON ELDERS
Credential	:
Telephone Number	:	714-788-1249

Provider Enumeration Date	:	05/27/2016
Last Update Date	:	10/14/2022

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