Provider Demographics
NPI:1215384722
Name:PROSPECT ECHN HOME HEALTH, INC.
Entity Type:Organization
Organization Name:PROSPECT ECHN HOME HEALTH, INC.
Other - Org Name:HOME CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JON
Authorized Official - Last Name:ELDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-788-1249
Mailing Address - Street 1:8 KEYNOTE DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5040
Mailing Address - Country:US
Mailing Address - Phone:860-872-9163
Mailing Address - Fax:860-872-3030
Practice Address - Street 1:8 KEYNOTE DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5040
Practice Address - Country:US
Practice Address - Phone:860-872-9163
Practice Address - Fax:860-872-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health