Provider Demographics
NPI:1629193156
Name:MIDSTATE VNA & HOSPICE INC
Entity Type:Organization
Organization Name:MIDSTATE VNA & HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPH
Authorized Official - Phone:203-235-5714
Mailing Address - Street 1:1 RESEARCH PKWY
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-8400
Mailing Address - Country:US
Mailing Address - Phone:203-235-5714
Mailing Address - Fax:203-630-9841
Practice Address - Street 1:1 RESEARCH PKWY
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-8400
Practice Address - Country:US
Practice Address - Phone:203-235-5714
Practice Address - Fax:203-630-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC81751251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT071531Medicare ID - Type UnspecifiedHOME CARE HOSPICE