Provider Demographics
NPI:1083927164
Name:VISITING NURSE ASSOCIATION OF WALLINGFORD, INC.
Entity Type:Organization
Organization Name:VISITING NURSE ASSOCIATION OF WALLINGFORD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:203-269-1475
Mailing Address - Street 1:135 N PLAINS INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2332
Mailing Address - Country:US
Mailing Address - Phone:203-269-1475
Mailing Address - Fax:203-265-5357
Practice Address - Street 1:135 N PLAINS INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2332
Practice Address - Country:US
Practice Address - Phone:203-269-1475
Practice Address - Fax:203-265-5357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4042800Medicaid
CT4042800Medicaid