Provider Demographics
NPI:1326027046
Name:LEDYARD REGIONAL VISITING NURSE AGENCY
Entity Type:Organization
Organization Name:LEDYARD REGIONAL VISITING NURSE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOETCHIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, CHCE
Authorized Official - Phone:860-464-8464
Mailing Address - Street 1:741 COLONEL LEDYARD HWY
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1511
Mailing Address - Country:US
Mailing Address - Phone:860-464-8464
Mailing Address - Fax:860-464-7605
Practice Address - Street 1:741 COLONEL LEDYARD HWY
Practice Address - Street 2:
Practice Address - City:LEDYARD
Practice Address - State:CT
Practice Address - Zip Code:06339-1511
Practice Address - Country:US
Practice Address - Phone:860-464-8464
Practice Address - Fax:860-464-7605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC81731251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT620OtherANTHEM BC PROVIDER #
CT4042909Medicaid
CTOV9961OtherHEALTHNET PROVIDER #
CTOV9961OtherHEALTHNET PROVIDER #
CT=========OtherAETNA