Provider Demographics
NPI:1699887737
Name:PLYMOUTH VISITING NURSE ASSOCIATION
Entity type:Organization
Organization Name:PLYMOUTH VISITING NURSE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHET
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:860-585-4026
Mailing Address - Street 1:244 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TERRYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06786-5901
Mailing Address - Country:US
Mailing Address - Phone:860-585-4026
Mailing Address - Fax:860-585-4063
Practice Address - Street 1:244 MAIN ST
Practice Address - Street 2:
Practice Address - City:TERRYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06786-5901
Practice Address - Country:US
Practice Address - Phone:860-585-4026
Practice Address - Fax:860-585-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC81911251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4043154Medicaid
CT685 ZGOtherANTHEM BC BS OF CT
CT004PPHA103OtherCCCI
CT4040027OtherSTATE FUNDED ELDERLY PROG
CT68VNA0074CT01OtherANTHEM BC BS OF CT
CT685 ZGOtherANTHEM BC BS OF CT