Provider Demographics
NPI:1902063951
Name:VISITING NURSE ASSOCIATION OF WALLINGFORD INC
Entity Type:Organization
Organization Name:VISITING NURSE ASSOCIATION OF WALLINGFORD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:203-269-1475
Mailing Address - Street 1:135 N PLAINS INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2332
Mailing Address - Country:US
Mailing Address - Phone:203-269-1475
Mailing Address - Fax:203-256-6367
Practice Address - Street 1:135 N PLAINS INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2332
Practice Address - Country:US
Practice Address - Phone:203-269-1475
Practice Address - Fax:203-256-6367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004767261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4042800Medicaid
077047Medicare UPIN