Provider Demographics
NPI:1306844865
Name:VISITING NURSE AND HOSPICE CARE OF SOUTHWESTERN CT, INC
Entity type:Organization
Organization Name:VISITING NURSE AND HOSPICE CARE OF SOUTHWESTERN CT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARDSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-276-3000
Mailing Address - Street 1:1266 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3546
Mailing Address - Country:US
Mailing Address - Phone:203-276-3000
Mailing Address - Fax:
Practice Address - Street 1:1266 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3546
Practice Address - Country:US
Practice Address - Phone:203-276-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC821073374U00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community BasedGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT071501Medicare ID - Type UnspecifiedHOSPICE PROVIDER NUMBER