Provider Demographics
NPI:1346215753
Name:NEW MILFORD VISITING NURSE ASSOCIATION, INC.
Entity Type:Organization
Organization Name:NEW MILFORD VISITING NURSE ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:SARA
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-354-2216
Mailing Address - Street 1:68 PARK LANE RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-2325
Mailing Address - Country:US
Mailing Address - Phone:860-354-2216
Mailing Address - Fax:860-350-2852
Practice Address - Street 1:68 PARK LANE RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2325
Practice Address - Country:US
Practice Address - Phone:860-354-2216
Practice Address - Fax:860-350-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC80307251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4042891Medicaid
CT4042891Medicaid