Provider Demographics
NPI:1679567093
Name:VISITING NURSES ASSOCIATION OF WALLINGFORD, INC.
Entity type:Organization
Organization Name:VISITING NURSES ASSOCIATION OF WALLINGFORD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
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:203-265-5357
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:203-265-5357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC81921251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT005VNAW427OtherCCCI (CT COMMUNITY CARE )
CT0X00CT6128OtherPHYSICIANS HEALTH CARE
CT252OtherANTHEM BLUE CROSS
A790501OtherOXFORD HEALTH PLAN
60-00095OtherUNITED HEALTHCARE
CT753138OtherCONNECTICARE
CT927643OtherAETNA/USHC
CT252OtherANTHEM BLUE CROSS
60-00095OtherUNITED HEALTHCARE
CT0X00CT6128OtherPHYSICIANS HEALTH CARE
CT927643OtherAETNA/USHC
CT077047Medicare ID - Type UnspecifiedMEDICARE