Provider Demographics
NPI:1427510460
Name:THE OPAL STORK NURSERY SERVICES, LLC
Entity type:Organization
Organization Name:THE OPAL STORK NURSERY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALMON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:203-589-2943
Mailing Address - Street 1:341 MAIN ST OFC K-1
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4432
Mailing Address - Country:US
Mailing Address - Phone:800-929-9317
Mailing Address - Fax:800-929-9317
Practice Address - Street 1:341 MAIN ST OFC K-1
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4432
Practice Address - Country:US
Practice Address - Phone:800-929-9317
Practice Address - Fax:800-929-9317
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPAL STORK HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty