Provider Demographics
NPI:1265490940
Name:VISITING NURSE ASSOCIATION OF SOUTHEASTERN CONNECTICUT
Entity Type:Organization
Organization Name:VISITING NURSE ASSOCIATION OF SOUTHEASTERN CONNECTICUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LENZINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-444-1111
Mailing Address - Street 1:403 N FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4349
Mailing Address - Country:US
Mailing Address - Phone:860-444-1111
Mailing Address - Fax:860-440-1156
Practice Address - Street 1:403 N FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4349
Practice Address - Country:US
Practice Address - Phone:860-444-1111
Practice Address - Fax:860-440-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT81671251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT207000172OtherBUSINESS PARTNER ID
CT004042511Medicaid
616OtherANTHEM BC BS PROVIDER ID