Provider Demographics
NPI:1336106582
Name:ROTARY HOME HEALTH CARE INCORPORATED
Entity Type:Organization
Organization Name:ROTARY HOME HEALTH CARE INCORPORATED
Other - Org Name:ROTARY DRUG INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MALYSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-378-9394
Mailing Address - Street 1:1030 BARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4985
Mailing Address - Country:US
Mailing Address - Phone:203-378-9394
Mailing Address - Fax:203-375-8651
Practice Address - Street 1:1030 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4985
Practice Address - Country:US
Practice Address - Phone:203-378-9394
Practice Address - Fax:203-375-8651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CTPCY00008983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004070926Medicaid
CT004075560Medicaid
1998400OtherPK
CT004070926Medicaid