Provider Demographics
NPI:1043589781
Name:VISITING NURSE & HOSPICE OF FAIRFIELD COUNTY, INC.
Entity Type:Organization
Organization Name:VISITING NURSE & HOSPICE OF FAIRFIELD COUNTY, INC.
Other - Org Name:WAVENY HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:V
Authorized Official - Last Name:KEMPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-594-5417
Mailing Address - Street 1:3 FARM RD
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-6626
Mailing Address - Country:US
Mailing Address - Phone:203-594-5248
Mailing Address - Fax:203-594-5309
Practice Address - Street 1:3 FARM RD
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-6626
Practice Address - Country:US
Practice Address - Phone:203-594-5248
Practice Address - Fax:203-594-5309
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISITING NURSE & HOSPICE OF FAIRFIELD COUNTY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTAPPLIED FOR251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT9915719Medicaid