MEDICARE: LEDYARD REGIONAL VISITING NURSE AGENCY

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	C81731	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	620	OTHER	CT	ANTHEM BC PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	OV9961	OTHER	CT	HEALTHNET PROVIDER #

General Provider Information

NPI Number	:	1326027046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEDYARD REGIONAL VISITING NURSE AGENCY

Provider Business Mailing Address
First Line	:	741 COLONEL LEDYARD HWY
Second Line	:
City	:	LEDYARD
State	:	CT
Zip	:	06339-1511
Country	:	US
Telephone Number	:	860-464-8464
Fax Number	:	860-464-7605

Provider Business Practice Location Address
First Line	:	741 COLONEL LEDYARD HWY
Second Line	:
City	:	LEDYARD
State	:	CT
Zip	:	06339-1511
Country	:	US
Telephone Number	:	860-464-8464
Fax Number	:	860-464-7605

Authorized Official
Title or Position	:	ADMINISTRATIVE SUPERVISOR
Name	:	MRS. KAREN GOETCHIUS
Credential	:	MSN, RN, CHCE
Telephone Number	:	860-464-8464

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	07/14/2008

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Directions to “LEDYARD REGIONAL VISITING NURSE AGENCY ” Practice Location

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