Provider Demographics
NPI:1043583966
Name:INTERIM HEALTHCARE OF SOUTHERN CONNECTICUT
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF SOUTHERN CONNECTICUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-810-8829
Mailing Address - Street 1:5 MYRTLE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06855-1315
Mailing Address - Country:US
Mailing Address - Phone:203-956-7555
Mailing Address - Fax:203-956-7557
Practice Address - Street 1:5 MYRTLE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06855-1315
Practice Address - Country:US
Practice Address - Phone:203-956-7555
Practice Address - Fax:203-956-7557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health