Provider Demographics
NPI:1710063367
Name:DAY KIMBALL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:DAY KIMBALL HEALTHCARE, INC.
Other - Org Name:DAY KIMBALL HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EX. DIR DKH HOMECARE/HOSPICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:860-928-0422
Mailing Address - Street 1:320 POMFRET ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1836
Mailing Address - Country:US
Mailing Address - Phone:860-928-0422
Mailing Address - Fax:860-928-4545
Practice Address - Street 1:320 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1836
Practice Address - Country:US
Practice Address - Phone:860-928-0422
Practice Address - Fax:860-928-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC9714710251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTA932151OtherOXFORD HEALTH PLANS
CTAA19631OtherHARVARD PILGRIM HEALTH CA
CT004043170Medicaid
CT004131231Medicaid
CT621OtherANTHEM BLUE CROSS BLUE SH
CT5541605OtherAETNA US HEALTHCARE
CT2174392002OtherUNITED HEALTHCARE
CTC9714710OtherHOME HEALTH AGENCY CT DEP
CT077097AMedicare ID - Type Unspecified
CT621OtherANTHEM BLUE CROSS BLUE SH
CT077097AMedicare ID - Type Unspecified